Q4259 HCPCS code: Celera dual layer or celera dual membrane, per square centimeter
Q4259 is the HCPCS Level II code for celera dual layer or celera dual membrane, per square centimeter. In 2024 Medicare paid an average of $969.01 per service for Q4259 across 17,215 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 39% from 2023 to 2024 (28,308 to 17,215 services). In 2024, about 166 clinicians billed Medicare for Q4259 for 351 beneficiaries; Alabama, Minnesota, Florida accounted for 42% of services.
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 | 2022-07-01 |
| Last action effective | 2022-07-01 |
Who bills Q4259 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 166 |
| Medicare beneficiaries | 351 |
| States with claims | 13 |
| Share of services in top 3 states (Alabama, Minnesota, Florida) | 42% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4259, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 28,308 | 411 | $975.50 | $777.21 |
| 2024 | 17,215 | 351 | $1,216.20 | $969.01 |
States with the most Q4259 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Alabama | 2,456 | $1,011.35 |
| Minnesota | 2,245 | $1,011.44 |
| Florida | 1,700 | $875.84 |
| Kansas | 1,556 | $1,011.44 |
| Texas | 1,415 | $923.92 |
What changed for Q4259
- 2022-07-01: Q4259 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 Q4259?
Q4259 is the HCPCS Level II code for celera dual layer or celera dual membrane, per square centimeter. Short descriptor: "Celera per sq cm".
How much does Medicare pay for Q4259?
In 2024, the average Medicare payment was $969.01 per service (average allowed $1,216.20).
Does Medicare cover Q4259?
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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q4259
- Watch Q4259 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4259
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.