HCPCS Level II · Miscellaneous services (temporary codes)
Q4289Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)
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Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About Q4289
Q4289 is an HCPCS Level II code in the Q series (miscellaneous services (temporary codes)), describing revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure).
It was added to HCPCS effective 01/01/2024, and its current record took effect 01/01/2026.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Revoshield+ amnio, per sq cm
- Date added
- 01/01/2024
- Action effective
- 01/01/2026
- BETOS
- O1E
Related Q42xx codes
- Q4200Skin te, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4201Matrion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4202Keroxx (2.5g/cc), 1cc
- Q4203Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4204Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4205Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4206Fluid flow or fluid gf, 1 cc
- Q4207Carbon life, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4208Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)
- Q4209Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4211Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4212Allogen, per cc
Common questions about Q4289
Is HCPCS Q4289 still valid?
- Yes. Q4289 is active in the CMS October 2026 HCPCS file.
Does Medicare cover Q4289?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.