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2026A Ambulatory Payment Classification: 6002
Title: HCT/P Skin Substitute Products
| 2026A Relative Weight: | 1.3908 |
| 2026A Payment Rate: | $127.14 |
| 2026A National Unadjusted Copay: | $ 0.00 |
| 2026A Minimum Unadjusted Copay: | $ 25.43 |
Addendum D1 Information
Status Indicator: S1
Item / Code / Service:
OPPS Payment Status:
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* Medicare Part A utilization data is derived from the 100% 2021 Outpatient (Fee-for-Service) Standard Analytical File.
Procedure Codes in this APC:
Q4115 Alloskin
Q4121 Theraskin
Q4123 Alloskin
Q4125 Arthroflex
Q4126 Memoderm/derma/tranz/integup
Q4128 Flexhd/allopatchhd/sq cm
Q4132 Grafix core, grafixpl core
Q4133 Grafix stravix prime pl sqcm
Q4134 Hmatrix
Q4137 Amnioexcel biodexcel 1sq cm
Q4138 Biodfence dryflex, 1cm
Q4140 Biodfence 1cm
Q4141 Alloskin ac, 1 cm
Q4142 Xcm biologic tiss matrix 1cm
Q4143 Repriza, 1cm
Q4147 Architect ecm px fx 1 sq cm
Q4148 Neox neox rt or clarix cord
Q4150 Allowrap ds or dry 1 sq cm
Q4151 Amnioband, guardian 1 sq cm
Q4152 Dermapure 1 square cm
Q4153 Dermavest, plurivest sq cm
Q4154 Biovance 1 square cm
Q4156 Neox 100 or clarix 100
Q4157 Revitalon 1 square cm
Q4160 Nushield 1 square cm
Q4163 Woundex, bioskin, per sq cm
Q4167 Truskin, per sq centimeter
Q4169 Artacent wound, per sq cm
Q4170 Cygnus, per sq cm
Q4173 Palingen or palingen xplus
Q4176 Neopatch or therion, 1 sq cm
Q4178 Floweramniopatch, per sq cm
Q4179 Flowerderm, per sq cm
Q4180 Revita, per sq cm
Q4181 Amnio wound, per square cm
Q4183 Surgigraft, 1 sq cm
Q4184 Cellesta or duo per sq cm
Q4186 Epifix 1 sq cm
Q4187 Epicord 1 sq cm
Q4188 Amnioarmor 1 sq cm
Q4190 Artacent ac 1 sq cm
Q4191 Restorigin 1 sq cm
Q4193 Coll-e-derm 1 sq cm
Q4194 Novachor 1 sq cm
Q4199 Cygnus matrix, per sq cm
Q4200 Skin te 1 sq cm
Q4204 Xwrap 1 sq cm
Q4205 Membrane graft or wrap sq cm
Q4208 Novafix per sq cm
Q4209 Surgraft per sq cm
Q4211 Amnion bio or axobio sq cm
Q4214 Cellesta cord per sq cm
Q4216 Artacent cord per sq cm
Q4217 Woundfix biowound plus xplus
Q4218 Surgicord per sq cm
Q4219 Surgigraft dual per sq cm
Q4220 Bellacell hd, surederm sq cm
Q4221 Amniowrap2 per sq cm
Q4227 Amniocore per sq cm
Q4229 Cogenex amnio memb per sq cm
Q4234 Xcellerate, per sq cm
Q4235 Amniorepair or altiply sq cm
Q4236 Carepatch per sq cm
Q4237 Cryo-cord, per sq cm
Q4239 Amnio-maxx or lite per sq cm
Q4247 Amniotext patch, per sq cm
Q4248 Dermacyte amn mem allo sq cm
Q4249 Amniply, per sq cm
Q4250 Amnioamp-mp per sq cm
Q4251 Vim, per square centimeter
Q4252 Vendaje, per square centimet
Q4253 Zenith amniotic membrane psc
Q4254 Novafix dl per sq cm
Q4255 Reguard, topical use per sq
Q4256 Mlg complet, per sq cm
Q4257 Relese, per sq cm
Q4258 Enverse, per sq cm
Q4259 Celera per sq cm
Q4260 Signature apatch, per sq cm
Q4261 Tag, per square centimeter
Q4262 Dual layer impax, per sq cm
Q4263 Surgraft tl, per sq cm
Q4264 Cocoon membrane, per sq cm
Q4265 Neostim tl per sq cm
Q4266 Neostim per sq cm
Q4267 Neostim dl per sq cm
Q4268 Surgraft ft per sq cm
Q4269 Surgraft xt per sq cm
Q4270 Complete sl per sq cm
Q4271 Complete ft per sq cm
Q4272 Esano a, per sq cm
Q4273 Esano aaa, per sq cm
Q4274 Esano ac, per sq cm
Q4275 Esano aca, per sq cm
Q4278 Epieffect, per sq cm
Q4279 Vendaje ac, per sq cm
Q4280 Xcell amnio matrix per sq cm
Q4281 Barrera slor dl per sq cm
Q4283 Biovance tri or 3l, sq cm
Q4284 Dermabind sl, per sq cm
Q4285 Nudyn dl or dl mesh pr sq cm
Q4286 Nudyn sl or slw, per sq cm
Q4287 Dermabind dl, per sq cm
Q4288 Dermabind ch, per sq cm
Q4289 Revoshield+ amnio, per sq cm
Q4290 Membrane wrap hydr per sq cm
Q4291 Lamellas xt, per sq cm
Q4292 Lamellas, per sq cm
Q4293 Acesso dl, per sq cm
Q4294 Amnio quad-core, per sq cm
Q4295 Amnio tri-core, per sq cm
Q4296 Rebound matrix, per sq cm
Q4298 Amnicore pro, per sq cm
Q4299 Amnicore pro+, per sq cm
Q4300 Acesso tl, per sq cm
Q4301 Activate matrix, per sq cm
Q4302 Complete aca, per sq cm
Q4303 Complete aa, per sq cm
Q4304 Grafix plus, per sq cm
Q4305 Amer am ac tri-lay per sq cm
Q4306 Americ amnion ac per sq cm
Q4307 American amnion, per sq cm
Q4308 Sanopellis, per sq cm
Q4309 Via matrix, per sq cm
Q4311 Acesso, per sq cm
Q4312 Acesso ac, per sq cm
Q4313 Dermabind fm, per sq cm
Q4314 Reeva, per sq cm
Q4315 Regenelink amniotic mem allo
Q4316 Amchoplast, per sq cm
Q4317 Vitograft, per sq cm
Q4318 E-graft, per sq cm
Q4319 Sanograft, per sq cm
Q4320 Pellograft, per sq cm
Q4321 Renograft, per sq cm
Q4322 Caregraft, per sq cm
Q4323 Alloply, per sq cm
Q4324 Amniotx, per sq cm
Q4325 Acapatch, per sq cm
Q4326 Woundplus, per sq cm
Q4327 Duoamnion, per sq cm
Q4328 Most, per sq cm
Q4329 Singlay, per sq cm
Q4330 Total, per sq cm
Q4331 Axolotl graft, per sq cm
Q4332 Axolotl dualgraft, per sq cm
Q4333 Ardeograft, per sq cm
Q4334 Amnioplast 1, per sq cm
Q4335 Amnioplast 2, per sq cm
Q4336 Artecent c, per sq cm
Q4337 Artecent trident, per sq cm
Q4338 Artacent velos, per sq cm
Q4339 Artacent vericlen, per sq cm
Q4340 Simpligraft, per sq cm
Q4341 Simplimax, per sq cm
Q4342 Theramend, per sq cm
Q4343 Dermacyte ac matrx per sq cm
Q4344 Tri membrane wrap, per sq cm
Q4345 Matrix hd allogrft per sq cm
Q4346 Shelter dm matrix per sq cm
Q4347 Rampart dl matrix per sq cm
Q4348 Sentry sl matrix per sq cm
Q4349 Mantle dl matrix per sq cm
Q4350 Palisade dm matrix per sq cm
Q4351 Enclose tl matrix, per sq cm
Q4352 Overlay sl matrix, per sq cm
Q4353 Xceed tl matrix per sq cm
Q4354 Palingen dl-palingen dl-x
Q4355 Abio xpl abio xpl hy p sq cm
Q4356 Abio mem abio hyd per sq cm
Q4357 Xwrap plus, per sq cm
Q4358 Xwrap dual, per sq cm
Q4359 Choriply, per sq cm
Q4360 Amchoplast fd per sq cm
Q4361 Epixpress, per sq cm
Q4362 Cygnus disk, per sq cm
Q4363 Am bur mem hydro per sq cm
Q4364 Am bur xp mem xpl hy p sq cm
Q4365 Amnio bur dl mem per sq cm
Q4366 Dl amnio bur x-mem per sq cm
Q4367 Amniocore sl, per sq cm
Q4368 Amchothick per sq cm
Q4369 Amnioplast 3 per sq cm
Q4370 Aeroguard per sq cm
Q4371 Neoguard per sq cm
Q4372 Amchoplast excl per sq cm
Q4373 Membrane wrp lt per sq cm
Q4375 Duograft ac per sq cm
Q4376 Duograft aa per sq cm
Q4377 Trigraft ft per sq cm
Q4378 Renew ft matrix per sq cm
Q4379 Amniodefend ft per sq cm
Q4380 Advograft one per sq cm
Q4382 Advograft dual per sq cm
Q4383 Axolotl graft ult per sq cm
Q4384 Axolotl dual ult per sq cm
Q4385 Apollo ft per sq cm
Q4386 Acesso trifaca per sq cm
Q4387 Neothelium ft per sq cm
Q4388 Neothelium 4l per sq cm
Q4389 Neothelium 4l+ per sq cm
Q4390 Ascendion per sq cm
Q4391 Amnioplast double per sq cm
Q4392 Grafix duo per sq cm
Q4393 Surgraft ac per sq cm
Q4394 Surgraft aca per sq cm
Q4395 Acelagraft per sq cm
Q4396 Natalin per sq cm
Q4397 Summit aaa per sq cm
Q4398 Summit ac per sq cm
Q4399 Summit fx per sq cm
Q4400 Polygon3 per sq cm
Q4401 Absolv3 per sq cm
Q4402 Xwrap 2.0 per sq cm
Q4403 Xwrap dual plus per sq cm
Q4404 Xwrap hydro plus per sq cm
Q4405 Xwrap fenestra plus sq cm
Q4406 Xwrap fenestra per sq cm
Q4407 Xwrap tribus per sq cm
Q4408 Xwrap hydro per sq cm
Q4409 Amniomatrixf3x per sq cm
Q4410 Amchomatrixdl per sq cm
Q4411 Amniomatrixf4x per sq cm
Q4412 Choriofix per sq cm
Q4413 Cygnus solo per sq cm
Q4414 Simplichor per sq cm
Q4415 Alexiguard st-l per sq cm
Q4416 Alexiguard tl-t per sq cm
Q4417 Alexiguard dl-t per sq cm
Q4420 Nuform per sq cm
Q4433 361 hct/p skin subs, nos
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Sources: Updates of Addendum A and B are posted quarterly to the OPPS website. These addenda are a "snapshot" of HCPCS codes and their status indicators,
APC groups, and OPPS payment rates, that are in effect at the beginning of each quarter. The quarterly updates of Addendum A and Addendum B reflect
the OPPS Pricer changes that are part of the quarterly OPPS recurring update notification transmittals.
http://www.cms.gov/HospitalOutpatientPPS/AU/list.asp#TopOfPage
For more information on the Composite APC payment,
please see CMS Transmittal R2141CP.
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