Descriptors and administrative fields exactly as published in the CMS HCPCS quarterly file.
Billing context: Q-codes
Units are reported in multiples of the dosage in the code descriptor.
One HCPCS billing unit of Q4128
1 SQ CM
No published MUE for Q4128. CMS keeps some MUE values confidential, so this does not mean there is no daily unit limit.
Medicare Part B drug payment limits per billing unit, by quarter, from the CMS payment limit (ASP) files.
Most recent Medicare Part B payment limit · Q4 2025
$29.912per 1 SQ CM
Effective Oct 1, 2025 – Dec 31, 2025 · ASP methodology (per CMS file) · based on Q2 2025 ASP data · coinsurance 20.000%
Not in the latest payment limit file (Q4 2026). Shown for history only.
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $29.912 | 1 SQ CM | 20% | −2.6% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $30.698 | 1 SQ CM | 20% | +25.5% | — |
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $24.467 | 1 SQ CM | 20% | −20.0% | — |
| Q1 2025 | Jan 1, 2025 – Mar 31, 2025 | $30.593 | 1 SQ CM |
Medicare hospital outpatient (OPPS) · Q4 2026
S1 See CMS Addendum D1
$127.140 per unit · APC 6002 · copayment $25.430 per unit
Washington Apple Health · professional claims
Not on HCA's professional administered drug fee schedule.
AAC = actual acquisition cost, based on NDC or invoice; BR = by report; NC = not covered; DC = not covered, see a different code; DP = covered under another program (see comments); PA = prior authorization; EPA = expedited prior authorization (see the billing guide); CPA = contractor prior authorization (Qualis). For professional claims; hospital-administered drugs are paid under HCA's outpatient (OPPS/EAPG) rules.
Packages CMS assigns to this code in its NDC–HCPCS crosswalks, with billable units per package. Only official crosswalk rows are shown.
No CMS NDC–HCPCS crosswalk rows were located. CMS notes its crosswalks are not a comprehensive list of all NDCs.
| NDC (11-digit) | CMS drug name · labeler | Pkg size × qty | Units / item | Units / NDC | Crosswalk | Quarters | FDA listing |
|---|---|---|---|---|---|---|---|
| 370205 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 10 × 1 | 10 | 10 | ASP | Q1 2024 – Q4 2025Not in Q4 2026 file | Not found |
| 370408 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q2 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 370505 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q4 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 371404 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 16 × 1 | 16 | 16 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 371408 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 371505 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q2 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 372404 alt ID | Allopatch HDMusculoskeletal Transplant Foundation | 16 × 1 | 16 | 16 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470102 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 2 | 2 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470204 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 8 | 8 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470205 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 10 × 1 | 10 | 10 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470307 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 21 | 21 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470407 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 28 | 28 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470408 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 470505 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471016 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 160 | 160 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471102 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 2 | 2 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471112 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 12 × 1 | 12 | 12 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471122 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 144 | 144 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471202 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 400 | 400 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471204 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 8 | 8 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471205 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 10 × 1 | 10 | 10 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471208 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 160 | 160 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471216 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 192 | 192 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471224 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 288 | 288 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471225 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 500 | 500 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471230 alt ID | FlexHDMusculoskeletal Transplant Foundation | 600 × 1 | 600 | 600 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471307 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 21 | 21 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471407 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 28 | 28 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471408 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471416 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 64 | 64 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471505 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471608 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 48 | 48 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471612 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 72 | 72 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471616 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471620 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471812 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 471816 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472016 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 160 | 160 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472224 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 288 | 288 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472225 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 500 | 500 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472230 alt ID | FlexHDMusculoskeletal Transplant Foundation | 600 × 1 | 600 | 600 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472407 alt ID | Flex StructuralMusculoskeletal Transplant Foundation | 28 × 1 | 28 | 28 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472408 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472505 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472620 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 472812 alt ID | FlexHDMusculoskeletal Transplant Foundation | 1 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 473505 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 474404 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 1 × 1 | 16 | 16 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 474408 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 32 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 474505 alt ID | AlloPatch HDMusculoskeletal Transplant Foundation | 25 × 1 | 25 | 25 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 479204 alt ID | FlexHDMusculoskeletal Transplant Foundation | 8 × 1 | 8 | 8 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 479407 alt ID | FlexHDMusculoskeletal Transplant Foundation | 28 × 1 | 28 | 28 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 4D1331 alt ID | FlexHDMusculoskeletal Transplant Foundation | 660 × 1 | 660 | 660 | ASP | Q3 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 4D1335 alt ID | FlexHDMusculoskeletal Transplant Foundation | 840 × 1 | 840 | 840 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 4d2331 alt ID | FlexHDMusculoskeletal Transplant Foundation | 660 × 1 | 660 | 660 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| 4D2335 alt ID | FlexHDMusculoskeletal Transplant Foundation | 840 × 1 | 840 | 840 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| FN0816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1102 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 2 × 1 | 2 | 2 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1202 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 400 × 1 | 400 | 400 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1204 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 8 × 1 | 8 | 8 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1208 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 160 × 1 | 160 | 160 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1220 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 240 × 1 | 240 | 240 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1407 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 28 × 1 | 28 | 28 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1412 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 48 × 1 | 48 | 48 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1416 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 64 × 1 | 64 | 64 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1620 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 320 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP1816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP2202 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 400 × 1 | 400 | 400 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP2208 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 160 × 1 | 160 | 160 | ASP | Q2 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP2616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP2620 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 320 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| HP2816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| NK0816 alt ID | FlexHD Pliable MaxMusculoskeletal Transplant Foundation | 128 × 2 | 128 | 256 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1202 alt ID | FlexHD Pliable PerforatedMusculoskeletal Transplant Foundation | 400 × 1 | 400 | 400 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1208 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 160 × 1 | 160 | 160 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1220 alt ID | FlexHD Pliable PerforatedMusculoskeletal Transplant Foundation | 240 × 1 | 240 | 240 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1620 alt ID | FlexHD Pliable PerforatedMusculoskeletal Transplant Foundation | 320 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF1816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF2202 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 400 × 1 | 400 | 400 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF2220 alt ID | Flex Pliable PerforatedMusculoskeletal Transplant Foundation | 240 × 1 | 240 | 240 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF2616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 1 | 96 | 96 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF2620 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 320 × 1 | 320 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PF2816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 1 | 128 | 128 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PK1208 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 160 × 2 | 160 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PK1616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 2 | 96 | 192 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PK1816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 2 | 128 | 256 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP0001 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 350 × 1 | 350 | 350 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP0002 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 389 × 1 | 389 | 389 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP0003 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 598 × 1 | 598 | 598 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP1500 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 322 × 1 | 322 | 322 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP1502 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 418 × 1 | 418 | 418 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP2001 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 350 × 1 | 350 | 350 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP2002 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 504 × 1 | 504 | 504 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PP2003 alt ID | Flex PliableMusculoskeletal Transplant Foundation | 598 × 1 | 598 | 598 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| RK1208 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 160 × 2 | 160 | 320 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| RK1616 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 96 × 2 | 96 | 192 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| RK1816 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 128 × 2 | 128 | 256 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1000 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 90 × 1 | 90 | 90 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1002 alt ID | FlexHDMusculoskeletal Transplant Foundation | 90 × 1 | 90 | 90 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1100 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 90 × 2 | 90 | 180 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1500 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 117 × 1 | 117 | 117 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1502 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 117 × 1 | 117 | 117 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF1515 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 117 × 2 | 117 | 234 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF2000 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 148 × 1 | 148 | 148 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF2002 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 148 × 1 | 148 | 148 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF2200 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 148 × 2 | 148 | 296 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF3000 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 189 × 1 | 189 | 189 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF3002 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 189 × 1 | 189 | 189 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF3300 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 189 × 2 | 189 | 378 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF4000 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 250 × 1 | 250 | 250 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF4002 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 250 × 1 | 250 | 250 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SF4400 alt ID | FlexHD Pliable Shaped PerforatedMusculoskeletal Transplant Foundation | 250 × 2 | 250 | 500 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0001 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 1 × 1 | 90 | 90 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0002 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 1 × 1 | 148 | 148 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0003 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 1 × 1 | 189 | 189 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0004 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 250 × 1 | 250 | 250 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0011 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 90 × 2 | 90 | 180 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0022 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 148 × 2 | 148 | 296 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0033 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 189 × 2 | 189 | 378 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP0044 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 360 × 2 | 360 | 720 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| sp1500 alt ID | FlexHDMusculoskeletal Transplant Foundation | 117 × 1 | 117 | 117 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP1502 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 117 × 1 | 117 | 117 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP1515 alt ID | FlexHDMusculoskeletal Transplant Foundation | 117 × 2 | 117 | 234 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP2001 alt ID | FlexHD PliableMusculoskeletal Transplant Foundation | 90 × 1 | 90 | 90 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP2002 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 148 × 1 | 148 | 148 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP2003 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 189 × 1 | 189 | 189 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| SP2004 alt ID | FlexHD Pliable ShapedMusculoskeletal Transplant Foundation | 250 × 1 | 250 | 250 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| WC0202 alt ID | AlloPatchMusculoskeletal Transplant Foundation | 4 × 1 | 4 | 4 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| WC0404 alt ID | WC AlloPatchMusculoskeletal Transplant Foundation | 1 × 1 | 16 | 16 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| WC0418 alt ID | WC AlloPatchMusculoskeletal Transplant Foundation | 1 × 1 | 32 | 32 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| WC1515 alt ID | AlloPatchMusculoskeletal Transplant Foundation | 2.25 × 1 | 2.25 | 3 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TD0405 alt ID | Matrix HDRTI Surgical | 20 × 1 | 20 | 20 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TD0508 alt ID | Matrix HDRTI Surgical | 40 × 1 | 40 | 40 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TD1010 alt ID | Matrix HDRTI Surgical | 100 × 1 | 100 | 100 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TD2203 alt ID | Matrix HDRTI Surgical | 6 × 1 | 6 | 6 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDF405 alt ID | Matrix HD FenestratedRTI Surgical | 20 × 1 | 20 | 20 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDF508 alt ID | Matrix HD FenestratedRTI Surgical | 40 × 1 | 40 | 40 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT346 alt ID | Acellular Dermal AllograftRTI Surgical | 24 × 1 | 24 | 24 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT358 alt ID | Acellular Dermal AllograftRTI Surgical | 40 × 1 | 40 | 40 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT546 alt ID | Acellular Dermal AllograftRTI Surgical | 24 × 1 | 24 | 24 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT558 alt ID | Acellular Dermal AllograftRTI Surgical | 40 × 1 | 40 | 40 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT646 alt ID | Acellular Dermal AllograftRTI Surgical | 24 × 1 | 24 | 24 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
| TDT658 alt ID | Acellular Dermal AllograftRTI Surgical | 40 × 1 | 40 | 40 | ASP | Q1 2023 – Q4 2025Not in Q4 2026 file | Not found |
Medicare coverage is set nationally (NCDs) and by each Medicare Administrative Contractor (LCDs and Billing & Coding articles). These links open the official documents.
Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.
Changes detected between the CMS quarterly HCPCS files CodeRx has imported.
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q1 2026 | Descriptor changed | C — Long description changed | Now: Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure)Before: Flex hd, or allopatch hd, per square centimeter |
| Q1 2026 | Dates changed | C — Long description changed | Added Jan 1, 2012 · action effective Jan 1, 2026 · termination — |
| Q1 2023 | In earliest ingested file | N — No maintenance | Added date Jan 1, 2012 |
All imported releases, checksums, and import reports are listed on the data sources page.
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| 20% |
| +0.3% |
| — |
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $30.500 | 1 SQ CM | 20% | −1.2% | — |
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| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $30.873 | 1 SQ CM | 20% | +0.6% | — |
|---|
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $30.689 | 1 SQ CM | 20% | −0.1% | — |
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| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $30.732 | 1 SQ CM | 20% | +0.1% | — |
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| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $30.699 | 1 SQ CM | 20% | −1.6% | — |
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| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $31.213 | 1 SQ CM | 20% | +0.0% | — |
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| Q2 2023 | Apr 1, 2023 – Jun 30, 2023 | $31.212 | 1 SQ CM | 20% | +1.7% | — |
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| Q1 2023 | Jan 1, 2023 – Mar 31, 2023 | $30.677 | 1 SQ CM | — | — | Added January 2023 |
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