Q4242 HCPCS code: Amniocyte plus, per 0.5 cc
Q4242 is the HCPCS Level II code for amniocyte plus, per 0.5 cc. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2020-07-01 |
| Last action effective | 2020-07-01 |
Medicare policy articles for this code
- A58865: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A58883: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58893: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A59374: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59434: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A59434: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A59764: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
- A59766: Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
What changed for Q4242
- 2020-07-01: Q4242 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q4242?
Q4242 is the HCPCS Level II code for amniocyte plus, per 0.5 cc. Short descriptor: "Amniocyte plus, per 0.5 cc".
Does Medicare cover Q4242?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related Q42 codes
- Q4200 — Skin te, per square centimeter
- Q4201 — Matrion, per square centimeter
- Q4202 — Keroxx (2.5g/cc), 1cc
- Q4203 — Derma-gide, per square centimeter
- Q4204 — Xwrap, per square centimeter
- Q4205 — Membrane graft or membrane wrap, per square centimeter
- Q4206 — Fluid flow or fluid gf, 1 cc
- Q4208 — Novafix, per square cenitmeter
- Q4209 — Surgraft, per square centimeter
- Q4210 — Axolotl graft or axolotl dualgraft, per square centimeter
- Q4211 — Amnion bio or axobiomembrane, per square centimeter
- Q4212 — Allogen, per cc
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Next steps
- Run a reimbursement report for a device billed under Q4242
- Watch Q4242 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4242
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.