HCPCS Level II › Q codes Q4433 361 hct/p skin subs, nos361 hct/p skin substitute product, not otherwise specified (list in addition to primary procedure)
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medicare pricing for Q4433 Physician Fee Schedule (CY 2026, RVU26D) Status C: contractor-priced by the MAC.
Payer policies and prior authorization for Q4433 14 of 14 payer prior-auth lists that name Q4433 require prior authorization or set conditions: CarePlus Health Plans, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of New Mexico, Molina Healthcare of Texas, Passport by Molina Healthcare (Kentucky).
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IN prior auth required New PA requirement Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Molina Healthcare of California Medicaid CA prior auth required Apr 1, 2026 Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 Molina Healthcare of Illinois Medicaid IL prior auth required Jan 26, 2026 Molina Healthcare of Illinois Codification Grid Q3 2026 Molina Healthcare of New Mexico Medicaid NM prior auth required Apr 1, 2026 New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 Molina Healthcare of Texas STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) TX prior auth required Refer to Texas Medicaid Provider Procedures Manual for skin substitute limitations Apr 1, 2026 Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 Passport by Molina Healthcare (Kentucky) Medicaid KY prior auth required Jan 1, 2026 Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Payer coverage policies that name Q4433 Q4433 appears in 10 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
Payer Policy Role in policy Reviewed Document Anthem Products for Wound Healing and Soft Tissue Grafting: Investigational (SURG.00011) unproven / investigational Aug 13, 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 Blue Cross & Blue Shield of Mississippi Bioengineered Skin And Soft Tissue Substitutes (A.7.01.113) unproven / investigational payer document Blue Cross Blue Shield of Massachusetts Bioengineered Skin and Soft Tissue Substitutes (663)Procedure unproven / investigational payer document Blue Cross NC Skin and Soft Tissue Substitutes listed, no stance (range Q4431-Q4433) Aug 1, 2026 payer document Centene Skin and Soft Tissue Substitutes (CP.MP.185)Allomax/Cortiva covered if criteria are met Apr 1, 2026 payer document Centene Skin and Soft Tissue Substitutes (CP.MP.185) not covered Apr 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 Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Bioengineered Skin and Soft Tissue Substitutes (SUR704.012)HCPCS Codes A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, listed, no stance Jul 1, 2026 payer document Premera Blue Cross Bioengineered Skin and Soft Tissue Substitutes (7.01.582)Page | 11 of 41 | ∞ unproven / investigational Oct 1, 2026 payer document Regence Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (Medicine 170) listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Jan 1, 2027: PA added, Humana Jul 1, 2026: PA added, Molina Healthcare of Texas Apr 1, 2026: PA added, Passport by Molina Healthcare (Kentucky) Apr 1, 2026: PA added, Molina Healthcare of Illinois Medicaid fee-for-service Prior authorization required or conditional in OH, WA.
IN: $42.97 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $55.03 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 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.