| HCPCS Code: |
Q4104 |
| Long Description: |
Integra bilayer matrix wound dressing (bmwd), per square centimeter |
| Short Description: |
Integra bmwd |
| Pricing Indicator 1: |
51 (Drugs) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
|
| Coverage Code: |
C (Carrier judgment) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
O1E (Other drugs) |
| Type of Service Code 1: |
1 (Medical care) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2009 |
| Action Effective Date: |
01-01-2014 |
| Action Code: |
P (Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)) |
