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Activate™ Matrix, per square centimeter, a skin substitute used in wound care.
2025 HCPCS code Q5118
Biosimilar bevacizumab-bvzr (Zirabev), 10 mg injection for intravenous infusion.
2025 HCPCS code Q4128
Processed human dermal allografts, including FlexHD®, AlloPatch® HD, or Matrix HD, per square centimeter, for surgical use in wound healing and tissue repair.
Artacent AC, 1 sq cm: Amniotic tissue-derived allograft used to promote healing and reduce inflammation and scarring.
2025 HCPCS code Q0247
Injection, sotrovimab, 500 mg.
2025 HCPCS code Q5106
Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 units
2025 HCPCS code Q4299
AmnioCore Pro+, per square centimeter. This code represents the supply of AmnioCore Pro+, a three-layer wound covering made from amniotic and chorionic membranes, used in wound care.
Pharmacy supplying fee for HIV pre-exposure prophylaxis (PrEP) FDA-approved prescription oral drug, per 90 days.
2025 HCPCS code Q0163
Diphenhydramine hydrochloride 50 mg oral, used to treat nausea and vomiting caused by chemotherapy.
2025 HCPCS code Q0164
Prochlorperazine maleate, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen.
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