Q4223 Dermabind sl optic per sq cmDermabind sl optic, per square centimeter (add-on, list separately in addition to primary procedure)
Status A: active, paid separately under the PFS if covered. National amounts: non-facility $127.26, facility $127.26 (total RVUs 3.81 / 3.81 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.00, practice expense RVU 3.81 non-facility and 3.81 facility, malpractice RVU 0.00. Global period ZZZ. Qualifying APM participants are paid at a $33.5675 conversion factor.
Q4223 appears in 4 coverage policies from Aetna, Anthem, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Mohs Micrographic Surgery (0383) | listed, no stance (range Q4100-Q4255) | May 28, 2026 | payer document |
| Anthem | Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses (CG-SURG-127) | covered if criteria are met | Aug 13, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Amniotic Membrane and Amniotic Fluid (SUR704.011) HCPCS Codes A2001, A2035, A2049, Q4132, Q4133, Q4137, Q4138, Q4139, Q4140, | listed, no stance | Dec 15, 2025 | payer document |
| Premera Blue Cross | Bioengineered Skin and Soft Tissue Substitutes (7.01.582) Page | 10 of 41 | ∞ | unproven / investigational | Oct 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.