LIST OF SKIN SUBSTITUTE PRODUCTS UTILIZED IN PFS PAYMENT RATE CALCULATIONS [1]		
		
		
CY 2025 HCPCS Code	CY 2025 Short Descriptor	FDA Regulatory Category
		
A2001	"Innovamatrix ac, per square centimeter"	510(k)
A2002	"Mirragen advanced wound matrix, per square centimeter"	510(k)
A2005	"Microlyte matrix, per square centimeter"	510(k)
A2006	"Novosorb synpath dermal matrix, per square centimeter"	510(k)
A2007	"Restrata, per square centimeter"	510(k)
A2008	"Theragenesis, per square centimeter"	510(k)
A2009	"Symphony, per square centimeter"	510(k)
A2010	"Apis, per square centimeter"	510(k)
A2011	"Supra sdrm, per square centimeter"	510(k)
A2012	"Suprathel, per square centimeter"	510(k)
A2013	"Innovamatrix fs, per square centimeter"	510(k)
A2015	"Phoenix wound matrix, per square centimeter"	510(k)
A2016	"Permeaderm b, per square centimeter"	510(k)
A2018	"Permeaderm c, per square centimeter"	510(k)
A2019	"Kerecis omega3 marigen shield, per square centimeter"	510(k)
A2021	"Neomatrix, per square centimeter"	510(k)
A2022	"Innovaburn or innovamatrix xl, per square centimeter"	510(k)
A2024	"Resolve matrix, per square centimeter"	510(k)
A2027	"Matriderm, per square centimeter "	510(k)
Q4101	"Apligraf, per square centimeter"	PMA
Q4102	"Oasis wound matrix, per square centimeter"	510(k)
Q4103	"Oasis burn matrix, per square centimeter"	510(k)
Q4104	"Integra bilayer matrix wound dressing (bmwd), per square centimeter"	510(k)
Q4105	"Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter"	PMA
Q4106	"Dermagraft, per square centimeter"	PMA
Q4107	"Graftjacket, per square centimeter"	510(k)
Q4108	"Integra matrix, per square centimeter"	PMA
Q4110	"Primatrix, per square centimeter"	510(k)
Q4111	"Gammagraft, per square centimeter"	510(k)
Q4115	"Alloskin, per square centimeter"	361 HCT/P
Q4116	"Alloderm, per square centimeter"	510(k)
Q4117	"Hyalomatrix, per square centimeter"	510(k)
Q4121	"Theraskin, per square centimeter"	361 HCT/P
Q4122	"Dermacell, dermacell awm or dermacell awm porous, per square centimeter"	510(k)
Q4123	"Alloskin rt, per square centimeter"	361 HCT/P
Q4124	"Oasis ultra tri-layer wound matrix, per square centimeter"	510(k)
Q4125	"Arthroflex, per square centimeter"	361 HCT/P
Q4126	"Memoderm, dermaspan, tranzgraft or integuply, per square centimeter"	361 HCT/P
Q4127	"Talymed, per square centimeter"	510(k)
Q4128	"Flex hd, or allopatch hd, per square centimeter"	361 HCT/P
Q4130	"Strattice tm, per square centimeter"	510(k)
Q4132	"Grafix core and grafixpl core, per square centimeter"	361 HCT/P
Q4133	"Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter"	361 HCT/P
Q4134	"Hmatrix, per square centimeter"	361 HCT/P
Q4135	"Mediskin, per square centimeter"	510(k)
Q4136	"Ez-derm, per square centimeter"	510(k)
Q4137	"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter"	361 HCT/P
Q4138	"Biodfence dryflex, per square centimeter"	361 HCT/P
Q4140	"Biodfence, per square centimeter"	361 HCT/P
Q4141	"Alloskin ac, per square centimeter"	361 HCT/P
Q4142	"Xcm biologic tissue matrix, per square centimeter"	361 HCT/P
Q4143	"Repriza, per square centimeter"	361 HCT/P
Q4146	"Tensix, per square centimeter"	510(k)
Q4147	"Architect, architect px, or architect fx, extracellular matrix, per square centimeter"	361 HCT/P
Q4148	"Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter"	361 HCT/P
Q4150	"Allowrap ds or dry, per square centimeter"	361 HCT/P
Q4151	"Amnioband or guardian, per square centimeter"	361 HCT/P
Q4152	"Dermapure, per square centimeter"	361 HCT/P
Q4153	"Dermavest and plurivest, per square centimeter"	361 HCT/P
Q4154	"Biovance, per square centimeter"	361 HCT/P
Q4156	"Neox 100 or clarix 100, per square centimeter"	361 HCT/P
Q4157	"Revitalon, per square centimeter"	361 HCT/P
Q4158	"Kerecis omega3, per square centimeter"	510(k)
Q4159	"Affinity, per square centimeter"	PMA
Q4160	"Nushield, per square centimeter"	361 HCT/P
Q4161	"Bio-connekt wound matrix, per square centimeter"	510(k)
Q4163	"Woundex, bioskin, per square centimeter"	361 HCT/P
Q4164	"Helicoll, per square centimeter"	510(k)
Q4165	"Keramatrix or kerasorb, per square centimeter"	510(k)
Q4166	"Cytal, per square centimeter"	510(k)
Q4167	"Truskin, per square centimeter"	361 HCT/P
Q4169	"Artacent wound, per square centimeter"	361 HCT/P
Q4170	"Cygnus, per square centimeter"	361 HCT/P
Q4173	"Palingen or palingen xplus, per square centimeter"	361 HCT/P
Q4175	"Miroderm, per square centimeter"	510(k)
Q4176	"Neopatch or therion, per square centimeter"	361 HCT/P
Q4178	"Floweramniopatch, per square centimeter"	361 HCT/P
Q4179	"Flowerderm, per square centimeter"	361 HCT/P
Q4180	"Revita, per square centimeter"	361 HCT/P
Q4181	"Amnio wound, per square centimeter"	361 HCT/P
Q4182	"Transcyte, per square centimeter"	PMA
Q4183	"Surgigraft, per square centimeter"	361 HCT/P
Q4184	"Cellesta or cellesta duo, per square centimeter"	361 HCT/P
Q4186	"Epifix, per square centimeter"	361 HCT/P
Q4187	"Epicord, per square centimeter"	361 HCT/P
Q4188	"Amnioarmor, per square centimeter"	361 HCT/P
Q4190	"Artacent ac, per square centimeter"	361 HCT/P
Q4191	"Restorigin, per square centimeter"	361 HCT/P
Q4193	"Coll-e-derm, per square centimeter"	361 HCT/P
Q4194	"Novachor, per square centimeter"	361 HCT/P
Q4195	"Puraply, per square centimeter"	510(k)
Q4196	"Puraply am, per square centimeter"	510(k)
Q4197	"Puraply xt, per square centimeter"	510(k)
Q4198	"Genesis amniotic membrane, per square centimeter"	510(k)
Q4199	"Cygnus matrix, per square centimeter"	361 HCT/P
Q4200	"Skin te, per square centimeter"	361 HCT/P
Q4201	"Matrion, per square centimeter"	510(k)
Q4203	"Derma-gide, per square centimeter"	510(k)
Q4204	"Xwrap, per square centimeter"	361 HCT/P
Q4205	"Membrane graft or membrane wrap, per square centimeter"	361 HCT/P
Q4208	"Novafix, per square cenitmeter"	361 HCT/P
Q4209	"Surgraft, per square centimeter"	361 HCT/P
Q4211	"Amnion bio or axobiomembrane, per square centimeter"	361 HCT/P
Q4214	"Cellesta cord, per square centimeter"	361 HCT/P
Q4216	"Artacent cord, per square centimeter"	361 HCT/P
Q4217	"Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter"	361 HCT/P
Q4218	"Surgicord, per square centimeter"	361 HCT/P
Q4219	"Surgigraft-dual, per square centimeter"	361 HCT/P
Q4220	"Bellacell hd or surederm, per square centimeter"	361 HCT/P
Q4221	"Amniowrap2, per square centimeter"	361 HCT/P
Q4222	"Progenamatrix, per square centimeter"	510(k)
Q4225	"Amniobind, per square centimeter"	510(k)
Q4226	"Myown skin, includes harvesting and preparation procedures, per square centimeter"	510(k)
Q4227	"Amniocore, per square centimeter"	361 HCT/P
Q4229	"Cogenex amniotic membrane, per square centimeter"	361 HCT/P
Q4232	"Corplex, per square centimeter"	510(k)
Q4234	"Xcellerate, per square centimeter"	361 HCT/P
Q4235	"Amniorepair or altiply, per square centimeter"	361 HCT/P
Q4236	"Carepatch, per square centimeter"	361 HCT/P
Q4237	"Cryo-cord, per square centimeter"	361 HCT/P
Q4238	"Derm-maxx, per square centimeter"	PMA
Q4239	"Amnio-maxx or amnio-maxx lite, per square centimeter"	361 HCT/P
Q4247	"Amniotext patch, per square centimeter"	361 HCT/P
Q4248	"Dermacyte amniotic membrane allograft, per square centimeter"	361 HCT/P
Q4249	"Amniply, for topical use only, per square centimeter"	361 HCT/P
Q4250	"Amnioamp-mp, per square centimeter"	361 HCT/P
Q4251	"Vim, per square centimeter"	361 HCT/P
Q4252	"Vendaje, per square centimeter"	361 HCT/P
Q4253	"Zenith amniotic membrane, per square centimeter"	361 HCT/P
Q4254	"Novafix dl, per square centimeter"	361 HCT/P
Q4255	"Reguard, for topical use only, per square centimeter"	361 HCT/P
Q4256	"Mlg-complete, per square centimeter"	361 HCT/P
Q4257	"Relese, per square centimeter"	361 HCT/P
Q4258	"Enverse, per square centimeter"	361 HCT/P
Q4259	"Celera dual layer or celera dual membrane, per square centimeter"	361 HCT/P
Q4260	"Signature apatch, per square centimeter"	361 HCT/P
Q4261	"Tag, per square centimeter"	361 HCT/P
Q4262	"Dual layer impax membrane, per square centimeter"	361 HCT/P
Q4263	"Surgraft tl, per square centimeter"	361 HCT/P
Q4264	"Cocoon membrane, per square centimeter"	361 HCT/P
Q4265	"Neostim tl, per square centimeter"	361 HCT/P
Q4266	"Neostim membrane, per square centimeter"	361 HCT/P
Q4267	"Neostim dl, per square centimeter"	361 HCT/P
Q4268	"Surgraft ft, per square centimeter"	361 HCT/P
Q4269	"Surgraft xt, per square centimeter"	361 HCT/P
Q4270	"Complete sl, per square centimeter"	361 HCT/P
Q4271	"Complete ft, per square centimeter"	361 HCT/P
Q4272	"Esano a, per square centimeter"	361 HCT/P
Q4273	"Esano aaa, per square centimeter"	361 HCT/P
Q4274	"Esano ac, per square centimeter"	361 HCT/P
Q4275	"Esano aca, per square centimeter"	361 HCT/P
Q4276	"Orion, per square centimeter"	510(k)
Q4278	"Epieffect, per square centimeter"	361 HCT/P
Q4279	"Vendaje ac, per sq cm N Low"	361 HCT/P
Q4280	"Xcell amnio matrix, per square centimeter"	361 HCT/P
Q4281	"Barrera sl or barrera dl, per square centimeter"	361 HCT/P
Q4282	"Cygnus dual, per square centimeter"	510(k)
Q4283	"Biovance tri-layer or biovance 3l, per square centimeter"	361 HCT/P
Q4284	"Dermabind sl, per square centimeter"	361 HCT/P
Q4285	"Nudyn dl or nudyn dl mesh, per square centimeter"	361 HCT/P
Q4286	"Nudyn sl or nudyn slw, per square centimeter"	361 HCT/P
Q4287	"Dermabind dl, per sq cm N Low"	361 HCT/P
Q4288	"Dermabind ch, per sq cm N Low"	361 HCT/P
Q4289	"Revoshield+ amnio, per sq cm N Low"	361 HCT/P
Q4290	Membrane wrap hydr per sq cm N Low	361 HCT/P
Q4291	"Lamellas xt, per sq cm N Low"	361 HCT/P
Q4292	"Lamellas, per sq cm N Low"	361 HCT/P
Q4293	"Acesso dl, per sq cm N Low"	361 HCT/P
Q4294	"Amnio quad-core, per sq cm"	361 HCT/P
Q4295	"Amnio tri-core, per sq cm N Low"	361 HCT/P
Q4296	"Rebound matrix, per sq cm N Low"	361 HCT/P
Q4297	"Emerge matrix, per sq cm N Low"	510(k)
Q4298	"Amnicore pro, per sq cm N Low"	361 HCT/P
Q4299	"Amnicore pro+, per sq cm N Low"	361 HCT/P
Q4300	"Acesso tl, per sq cm N Low"	361 HCT/P
Q4301	"Activate matrix, per sq cm N Low"	361 HCT/P
Q4302	"Complete aca, per sq cm N Low"	361 HCT/P
Q4303	"Complete aa, per sq cm N Low"	361 HCT/P
Q4304	"Grafix plus, per sq cm N"	361 HCT/P
Q4305	Amer am ac tri-lay per sq cm	361 HCT/P
Q4306	Americ amnion ac per sq cm	361 HCT/P
Q4307	"American amnion, per sq cm"	361 HCT/P
Q4308	"Sanopellis, per sq cm"	361 HCT/P
Q4309	"Via matrix, per sq cm"	361 HCT/P
Q4311	"Acesso, per square centimeter"	361 HCT/P
Q4312	"Acesso ac, per square centimeter"	361 HCT/P
Q4313	"Dermabind fm, per square centimeter"	361 HCT/P
Q4314	"Reeva ft, per square centimeter"	361 HCT/P
Q4315	"Regenelink amniotic membrane allograft, per square centimeter"	361 HCT/P
Q4316	"Amchoplast, per square centimeter"	361 HCT/P
Q4317	"Vitograft, per square centimeter"	361 HCT/P
Q4318	"E-graft, per square centimeter"	361 HCT/P
Q4319	"Sanograft, per square centimeter"	361 HCT/P
Q4320	"Pellograft, per square centimeter"	361 HCT/P
Q4321	"Renograft, per square centimeter"	361 HCT/P
Q4322	"Caregraft, per square centimeter"	361 HCT/P
Q4323	"Alloply, per square centimeter"	361 HCT/P
Q4324	"Amniotx, per square centimeter"	361 HCT/P
Q4325	"Acapatch, per square centimeter"	361 HCT/P
Q4326	"Woundplus, per square centimeter"	361 HCT/P
Q4327	"Duoamnion, per square centimeter"	361 HCT/P
Q4328	"Most, per square centimeter"	361 HCT/P
Q4329	"Singlay, per square centimeter"	361 HCT/P
Q4330	"Total, per square centimeter"	361 HCT/P
Q4331	"Axolotl graft, per square centimeter"	361 HCT/P
Q4332	"Axolotl dualgraft, per square centimeter"	361 HCT/P
Q4333	"Ardeograft, per square centimeter"	361 HCT/P
Q4334	"Amnioplast 1, per square centimeter"	361 HCT/P
Q4335	"Amnioplast 2, per square centimeter"	361 HCT/P
Q4336	"Artacent c, per square centimeter"	361 HCT/P
Q4337	"Artacent trident, per square centimeter"	361 HCT/P
Q4338	"Artacent velos, per square centimeter"	361 HCT/P
Q4339	"Artacent vericlen, per square centimeter"	361 HCT/P
Q4340	"Simpligraft, per square centimeter"	361 HCT/P
Q4341	"Simplimax, per square centimeter"	361 HCT/P
Q4342	"Theramend, per square centimeter"	361 HCT/P
Q4343	"Dermacyte ac matrix amniotic membrane allograft, per square centimeter"	361 HCT/P
Q4344	"Tri-membrane wrap, per square centimeter"	361 HCT/P
Q4345	"Matrix hd allograft dermis, per square centimeter"	361 HCT/P
Q4346	"Shelter dm matrix, per square centimeter"	361 HCT/P
Q4347	"Rampart dl matrix, per square centimeter"	361 HCT/P
Q4348	"Sentry sl matrix, per square centimeter"	361 HCT/P
Q4349	"Mantle dl matrix, per square centimeter"	361 HCT/P
Q4350	"Palisade dm matrix, per square centimeter"	361 HCT/P
Q4351	"Enclose tl matrix, per square centimeter"	361 HCT/P
Q4352	"Overlay sl matrix, per square centimeter"	361 HCT/P
Q4353	"Xceed tl matrix, per square centimeter"	361 HCT/P
Q4354	Palingen dual-layer sq cm	361 HCT/P
Q4355	Abio xpl abio xpl hy p sq cm	361 HCT/P
Q4356	Abio mem abio hyd per sq cm	361 HCT/P
Q4357	"Xwrap plus, per sq cm"	361 HCT/P
Q4358	"Xwrap dual, per sq cm"	361 HCT/P
Q4359	"Choriply, per sq cm"	361 HCT/P
Q4360	Amchoplast fd per sq cm	361 HCT/P
Q4361	"Epixpress, per sq cm"	361 HCT/P
Q4362	"Cygnus disk, per sq cm"	361 HCT/P
Q4363	Am bur mem hydro per sq cm	361 HCT/P
Q4364	Am bur xp mem xpl hy p sq cm	361 HCT/P
Q4365	Amnio bur dl mem per sq cm	361 HCT/P
Q4366	Dl amnio bur x-mem per sq cm	361 HCT/P
Q4367	"Amniocore sl, per sq cm"	361 HCT/P
Q4368	Amchothick per sq cm	361 HCT/P
Q4369	Amnioplast 3 per sq cm	361 HCT/P
Q4370	Aeroguard per sq cm	361 HCT/P
Q4371	Neoguard per sq cm	361 HCT/P
Q4372	Amchoplast excl per sq cm	361 HCT/P
Q4373	Membrane wrp lt per sq cm	361 HCT/P
Q4375	Duograft ac per sq cm	361 HCT/P
Q4376	Duograft aa per sq cm	361 HCT/P
Q4377	Trigraft ft per sq cm	361 HCT/P
Q4378	Renew ft matrix per sq cm	361 HCT/P
Q4379	Amniodefend ft per sq cm	361 HCT/P
Q4380	Advograft one per sq cm	361 HCT/P
Q4382	Advograft dual per sq cm	361 HCT/P
