Q4289 HCPCS code: Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)
Q4289 is the HCPCS Level II code for revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure). In 2024 Medicare paid an average of $1,665.51 per service for Q4289 across 10,256 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. In 2024, about 38 clinicians billed Medicare for Q4289 for 196 beneficiaries; Florida, Illinois, New Jersey accounted for 78% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | O1E — Other drugs |
| Added | 2024-01-01 |
| Last action effective | 2026-01-01 |
Who bills Q4289 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 38 |
| Medicare beneficiaries | 196 |
| States with claims | 6 |
| Share of services in top 3 states (Florida, Illinois, New Jersey) | 78% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4289, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 10,256 | 196 | $2,090.38 | $1,665.51 |
States with the most Q4289 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,583 | $1,478.44 |
| Illinois | 2,304 | $1,509.65 |
| New Jersey | 1,432 | $1,683.65 |
| Maryland | 859 | $2,025.00 |
| New York | 588 | $1,516.69 |
What changed for Q4289
- January 2026: Descriptor revised (Was: Revoshield + amniotic barrier, per square centimeter)
- 2024-01-01: Q4289 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 Q4289?
Q4289 is the HCPCS Level II code for revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure). Short descriptor: "Revoshield+ amnio, per sq cm".
How much does Medicare pay for Q4289?
In 2024, the average Medicare payment was $1,665.51 per service (average allowed $2,090.38).
Does Medicare cover Q4289?
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 (add-on, list separately in addition to primary procedure)
- Q4201 — Matrion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4202 — Keroxx (2.5g/cc), 1cc
- Q4203 — Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4204 — Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4205 — Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4206 — Fluid flow or fluid gf, 1 cc
- Q4207 — Carbon life, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4208 — Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)
- Q4209 — Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4210 — Axolotl graft or axolotl dualgraft, per square centimeter
- Q4211 — Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)
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Next steps
- Run a reimbursement report for a device billed under Q4289
- Watch Q4289 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4289
Sources: CMS HCPCS Level II release October 2026; 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.