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HCPCS Q4145 · Level II · skin substitute code

Q4145: Epifix, injectable, 1 mg, HCPCS Level II skin substitute code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for Q4145

Medicare payment
no PFS amount
PFS status C
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
7 / 7

TL;DR

Q4145 is a Level II code from the Q section (temporary codes), in use since 2014: "Epifix, injectable, 1 mg". The physician fee schedule lists Q4145 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it. 7 active LCDs and 7 billing and coding articles list Q4145 across 26 states plus DC and 2 territories: L39624 (Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound), L39116 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound), A58865, A58883. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 13; type of service 1 (medical care). 1 other active code opens with "Epifix"; related codes: Q4186, Q4133, Q4158, Q4159.

Q4145 descriptor and code status

The October 2026 HCPCS Level II file describes Q4145 as “Epifix, injectable, 1 mg”. It sits in the Q section (temporary codes), listed with the other Skin substitute codes (Q4101-Q4399 and A2001-A2050).

HCPCS file attributes of Q4145
FieldValue
Short descriptorEpifix, inj, 1mg
Added to HCPCS2014-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryO1E: other drugs
Type of service1: medical care

Medicare payment for Q4145

The physician fee schedule lists Q4145 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status C: contractor-priced: the MAC sets RVUs and payment case by case. Global period XXX (global surgery concept does not apply); PC/TC indicator 3 (technical component only).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for Q4145

CMS publishes no MUE for Q4145 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for Q4145 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists Q4145 in v323r0.

Q4145 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check Q4145 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for Q4145

7 active Local Coverage Determinations and 7 billing and coding articles list Q4145. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

  • Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound, LCD L39624 · Wisconsin Physicians Service Insurance Corporation
  • L39116 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · Noridian Healthcare Solutions, LLC
  • L39128 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · Palmetto GBA
  • L39139 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · Wellpoint Federal
  • L39575 Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · CGS Administrators, LLC
  • L39877 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · First Coast Service Options, Inc.
  • L39879 Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound · Novitas Solutions, Inc.
Billing and Coding Articles listing Q4145
ArticleTitleContractor(s)Related LCD
A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundNoridian Healthcare Solutions, LLCL39116
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundPalmetto GBAL39128
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundWellpoint FederalL39139
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundCGS Administrators, LLCL39575
A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundWisconsin Physicians Service Insurance CorporationL39624
A59764Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundFirst Coast Service Options, Inc.L39877
A59766Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-WoundNovitas Solutions, Inc.L39879

Denials to expect on Q4145

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists Q4145

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for Q4145 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for Q4145 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS Q4145

What does HCPCS code Q4145 describe?

"Epifix, injectable, 1 mg" (short descriptor "Epifix, inj, 1mg"), in the Q section (temporary codes). Added 2014-01-01; last action N (no maintenance) effective 2026-01-01.

Is Q4145 a CPT code?

No. Q4145 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for Q4145?

The physician fee schedule lists Q4145 with status C (contractor-priced: the MAC sets RVUs and payment case by case), so the PFS carries no national amount for it.

Does Medicare cover Q4145?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 7 active LCDs and 7 billing and coding articles list Q4145 across 26 states plus DC and 2 territories: L39624 (Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound), L39116 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound), A58865, A58883.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.