HCPCS Code Section: HCPCS Q Codes

Integra matrix, per square centimeter Short Description: Integra matrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: January 1, …

Cast supplies, short leg splint, pediatric (0-10 years), plaster Short Description: Cast sup sht leg splnt ped p Coverage Code: Carrier judgment Action Code: No maintenance for this code …

Graftjacket, per square centimeter Short Description: Graftjacket Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: January 1, 2014 Termination …

Cast supplies, short leg splint, adult (11 years +), fiberglass Short Description: Cast sup sht leg splnt fbrgl Coverage Code: Carrier judgment Action Code: No maintenance for this code …

Dermagraft, per square centimeter Short Description: Dermagraft Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: January 1, 2014 Termination …

Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter Short Description: Integra drt or omnigraft Coverage Code: Carrier judgment Action Code: No maintenance for …

Integra bilayer matrix wound dressing (bmwd), per square centimeter Short Description: Integra bmwd Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 …

Oasis burn matrix, per square centimeter Short Description: Oasis burn matrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: …

Oasis wound matrix, per square centimeter Short Description: Oasis wound matrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: …

Apligraf, per square centimeter Short Description: Apligraf Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2009 Effective Date: January 1, 2014 Termination …