Q4205 – Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)

Long description

Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)

Short description

Membrane graft or wrap sq cm

Pricing indicator

11 Priced using national RVUs (Physician Fee Schedule)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

O1E Other drugs

ASC

Approved for ambulatory surgical centers

Added

October 1, 2019

Last change

January 1, 2026 – No change

Nearby Q codes

• Q4197 – Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4198 – Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4199 – Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4200 – Skin te, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4201 – Matrion, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4202 – Keroxx (2.5g/cc), 1cc
• Q4203 – Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4204 – Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4206 – Fluid flow or fluid gf, 1 cc
• Q4207 – Carbon life, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4208 – Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)
• Q4209 – Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4210 – Axolotl graft or axolotl dualgraft, per square centimeter
• Q4211 – Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)
• Q4212 – Allogen, per cc
• Q4213 – Ascent, 0.5 mg