Q4243 Amchomatrix, per sq cmAmchomatrix, 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.
3 of 3 payer prior-auth lists that name Q4243 require prior authorization or set conditions: Cigna.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
Q4243 appears in 4 coverage policies from Aetna, Blue Cross NC, 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 |
| Blue Cross NC | Skin and Soft Tissue Substitutes | listed, no stance (range Q4242-Q4250) | Aug 1, 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.