HCPCS Code Details - Q4108

HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q4108
Description

Long description:
Integra matrix, per square centimeter

Short description:
Integra matrix

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jan 01, 2014
Date added Added Jan 01, 2009
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - Q4108

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
1 SQ CM 45.48 - - - - - -
1 SQ CM 40.7 - - - - - -
1 SQ CM 36.539 - - - - - -
1 SQ CM 31.816 - - - - - -
1 SQ CM 35.627 - - - - - -

See also


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”