HCPCS Level II · Miscellaneous services (temporary codes)
Q4120Matristem burn matrix, per square centimeter
Terminated 12/31/2016
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About Q4120
Q4120 is an HCPCS Level II code in the Q series (miscellaneous services (temporary codes)), describing matristem burn matrix, per square centimeter.
It was added to HCPCS effective 01/01/2011, and its current record took effect 01/01/2017.
It was terminated on 12/31/2016 and can't be billed for later dates of service.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Matristem burn matrix
- Date added
- 01/01/2011
- Action effective
- 01/01/2017
- Termination date
- 12/31/2016
- BETOS
- O1E
Related Q41xx codes
- Q4101Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4102Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4103Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4104Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
- Q4105Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4107Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4108Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4110Primatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4111Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4112Cymetra, injectable, 1 cc
- Q4113Graftjacket xpress, injectable, 1 cc
- Q4114Integra flowable wound matrix, injectable, 1 cc
Common questions about Q4120
Is HCPCS Q4120 still valid?
- No. Q4120 was terminated on 12/31/2016.
Does Medicare cover Q4120?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.