Summary & Overview
HCPCS Level II Q4145: Epifix Injectable, 1 mg
HCPCS Level II code Q4145 denotes Epifix injectable, 1 mg, an injectable therapeutic biologic. This code identifies administration or supply of a specific biologic product used in outpatient and ambulatory care settings. Nationally, accurate coding of product-specific HCPCS Level II codes matters for clinical documentation, inventory tracking, payer adjudication, and aggregate reporting of biologic usage.
Key payers commonly involved in coverage and reimbursement for this type of product include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of what the code represents, common payer coverage considerations, and the clinical and billing context for use of a one-milligram injectable biologic.
This publication provides benchmarks and policy context relevant to coding and billing with HCPCS Level II codes for injectable biologics, highlights typical sites of service and service type, and notes where input data are not available. It is intended for billing and coding professionals, revenue cycle managers, and clinicians who require a clear, national-level reference for HCPCS Level II code Q4145 and associated administrative considerations.
Billing Code Overview
HCPCS Level II code Q4145 represents Epifix, injectable, 1 mg, an injectable biologic product. The service is a therapeutic injectable used for clinical indications consistent with the product description.
Service Type: Injectable therapeutic product
Typical Site of Service: Outpatient clinic, physician office, or ambulatory care setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a nonhealing or complex soft-tissue wound (for example, a diabetic foot ulcer, venous stasis ulcer, or surgical dehiscence) referred to a wound care clinic or outpatient surgical practice for advanced biologic therapy. The clinician performs a wound assessment, documents wound size, depth, presence of infection, and prior treatments. After conservative measures (debridement, offloading, dressings, antibiotics as indicated) fail or when the wound meets criteria for biologic grafting, the provider prepares Q4145 (Epifix, injectable, 1 mg) for local application into the wound bed or wound margins to promote healing.
The clinical workflow includes informed consent and documentation of wound characteristics, anesthesia or local analgesia if required, preparation of the injectable product under aseptic technique, and application into the wound base or surrounding tissue. The clinician documents the exact quantity administered in milligrams, the date of service, wound measurements, and any concurrent procedures (for example, surgical debridement). The product may be billed by the supplying facility or provider using Q4145 with appropriate modifier(s) reflecting the encounter circumstances and billing responsibility. Typical site of service is an outpatient wound care center, outpatient clinic, ambulatory surgical center, or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|