Q4289 — Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)
Q4289 is a HCPCS Level II code for revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure). It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 0.00
- PE (non-facility)
- 3.81
- PE (facility)
- 3.81
- Malpractice RVU
- 0.00
Global period: ZZZ
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The CMS record for Q4289
- Long descriptor
- Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)
- Short descriptor
- Revoshield+ amnio, per sq cm
- Added
- January 1, 2024
- BETOS
- O1E
- Pricing indicator
- 11 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established using national RVUs.
Codes adjacent to Q4289
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q4289 is not quite right, the correct code is very often within a few positions of it.
- Q4281Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4282Cygnus dual, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4283Biovance tri-layer or biovance 3l, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4284Dermabind sl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4285Nudyn dl or nudyn dl mesh, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4286Nudyn sl or nudyn slw, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4287Dermabind dl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4288Dermabind ch, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4290Membrane wrap-hydro, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4291Lamellas xt, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4292Lamellas, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4293Acesso dl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4294Amnio quad-core, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4295Amnio tri-core amniotic, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4296Rebound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4297Emerge matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Questions about Q4289
What is HCPCS code Q4289?
Q4289 is a HCPCS Level II code for revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure). It sits in the Temporary Codes section.
Does Medicare cover Q4289?
The CMS HCPCS file marks Q4289 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is Q4289 paid under the physician fee schedule?
Q4289 carries PFS status code A. Active code. Paid separately under the physician fee schedule.