HCPCS Code Details - Q4128

HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q4128
Description

Long description:
Flex hd, or allopatch hd, per square centimeter

Short description:
Flexhd/allopatchhd/sq cm

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 Oct 01, 2022
Date added Added Jan 01, 2012
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 - Q4128

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
April 1, 2024 - June 30, 2024 1 SQ CM 30.689 - - - - - -
January 1, 2024 - March 31, 2024 1 SQ CM 30.732 - - - - - -
October 1, 2023 - December 31, 2023 1 SQ CM 30.699 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 1 SQ CM 31.213 20% - - - - -
April 1, 2023 - June 30, 2023 1 SQ CM 31.212 20% - - - - -

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”