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 Q4173
1 SQ CM
No published MUE for Q4173. 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
$349.015per 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 | $349.015 | 1 SQ CM | 20% | −2.1% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $356.554 | 1 SQ CM | 20% | −1.1% | — |
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $360.508 | 1 SQ CM | 20% | +4.9% | Added April 2025 |
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $343.509 | 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 |
|---|---|---|---|---|---|---|---|
| PH-030101 alt ID | Palingen HydromembraneAmnio Technology, LLC | 1 × 1 | 1 | 1 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030102 alt ID | Palingen HydromembraneAmnio Technology, LLC | 2 × 1 | 2 | 2 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030202 alt ID | Palingen HydromembraneAmnio Technology, LLC | 4 × 1 | 4 | 4 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030203 alt ID | Palingen HydromembraneAmnio Technology, LLC | 6 × 1 | 6 | 6 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030204 alt ID | Palingen HydromembraneAmnio Technology, LLC | 8 × 1 | 8 | 8 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030206 alt ID | Palingen HydromembraneAmnio Technology, LLC | 12 × 1 | 12 | 12 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030404 alt ID | Palingen HydromembraneAmnio Technology, LLC | 16 × 1 | 16 | 16 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030406 alt ID | Palingen HydromembraneAmnio Technology, LLC | 24 × 1 | 24 | 24 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030408 alt ID | Palingen HydromembraneAmnio Technology, LLC | 32 × 1 | 32 | 32 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PH-030808 alt ID | Palingen HydromembraneAmnio Technology, LLC | 64 × 1 | 64 | 64 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020101 alt ID | PalinGen MembraneAmnio Technology, LLC | 1 × 1 | 1 | 1 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020102 alt ID | PalinGen MembraneAmnio Technology, LLC | 2 × 1 | 2 | 2 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020202 alt ID | PalinGen MembraneAmnio Technology, LLC | 4 × 1 | 4 | 4 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020203 alt ID | PalinGen MembraneAmnio Technology, LLC | 6 × 1 | 6 | 6 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020204 alt ID | PalinGen MembraneAmnio Technology, LLC | 8 × 1 | 8 | 8 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020206 alt ID | PalinGen MembraneAmnio Technology, LLC | 12 × 1 | 12 | 12 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020404 alt ID | PalinGen MembraneAmnio Technology, LLC | 16 × 1 | 16 | 16 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020406 alt ID | PalinGen MembraneAmnio Technology, LLC | 24 × 1 | 24 | 24 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020408 alt ID | PalinGen MembraneAmnio Technology, LLC | 32 × 1 | 32 | 32 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| PM-020808 alt ID | PalinGen MembraneAmnio Technology, LLC | 64 × 1 | 64 | 64 | ASP | Q3 2023 – Q4 2025Not in Q4 2026 file | Not found |
| PM-021020 alt ID | PalinGen MembraneAmnio Technology, LLC | 200 × 1 | 200 | 200 | ASP | Q4 2023 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040101 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 1 × 1 | 1 | 1 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040102 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 2 × 1 | 2 | 2 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040202 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 4 × 1 | 4 | 4 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040203 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 6 × 1 | 6 | 6 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040204 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 8 × 1 | 8 | 8 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040206 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 12 × 1 | 12 | 12 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040404 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 16 × 1 | 16 | 16 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040406 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 24 × 1 | 24 | 24 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040408 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 32 × 1 | 32 | 32 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XH-040808 alt ID | Palingen XPlus HydromembraneAmnio Technology, LLC | 64 × 1 | 64 | 64 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020101 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 1 × 1 | 1 | 1 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020102 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 2 × 1 | 2 | 2 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020202 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 4 × 1 | 4 | 4 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020203 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 6 × 1 | 6 | 6 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020204 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 8 × 1 | 8 | 8 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020206 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 12 × 1 | 12 | 12 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020404 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 16 × 1 | 16 | 16 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020406 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 24 × 1 | 24 | 24 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020408 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 32 × 1 | 32 | 32 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-020808 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 64 × 1 | 64 | 64 | ASP | Q2 2021 – Q4 2025Not in Q4 2026 file | Not found |
| XM-021020 alt ID | Palingen XPlus MembraneAmnio Technology, LLC | 200 × 1 | 200 | 200 | ASP | Q4 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: Palingen or palingen xplus, per square centimeter (add-on, list separately in addition to primary procedure)Before: Palingen or palingen xplus, per square centimeter |
| Q1 2026 | Dates changed | C — Long description changed | Added Jan 1, 2017 · action effective Jan 1, 2026 · termination — |
| Q1 2023 | In earliest ingested file | N — No maintenance | Added date Jan 1, 2017 |
All imported releases, checksums, and import reports are listed on the data sources page.
Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.
| 20% |
| −14.7% |
| — |
| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $402.514 | 1 SQ CM | 20% | +2.1% | — |
|---|
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $394.057 | 1 SQ CM | 20% | +2.8% | — |
|---|
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $383.249 | 1 SQ CM | 20% | −4.4% | — |
|---|
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $400.835 | 1 SQ CM | 20% | +9.1% | — |
|---|
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $367.452 | 1 SQ CM | 20% | +75.1% | Added July 2023 |
|---|
| Q2 2021 | Apr 1, 2021 – Jun 30, 2021 | $209.824 | 1 SQ CM | — | — | Added April 2021 |
|---|