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 …

Theraskin, per square centimeter Short Description: Theraskin Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2011 Effective Date: January 1, 2018 Termination …

Matristem burn matrix, per square centimeter Short Description: Matristem burn matrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2011 Effective Date: …

Matristem wound matrix, per square centimeter Short Description: Matristem wound matrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2011 Effective Date: …

Matristem micromatrix, 1 mg Short Description: Matristem micromatrix Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2011 Effective Date: January 1, 2014 …