Summary & Overview
HCPCS Level II Q4174: Palingen/Promatrx Injectable 0.36 mg per 0.25 cc
HCPCS Level II code Q4174 identifies a specific injectable formulation: Palingen or Promatrx, 0.36 mg per 0.25 cc. As a HCPCS Level II drug supply code, it matters nationally for billing and reporting of specialty injectable therapies administered in outpatient and ambulatory settings. Clear coding supports appropriate coverage determinations, medical necessity review, and consistent claims processing across payers.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and typical sites of service, plus what to expect in payer coverage practices and billing workflows. The publication outlines benchmarks and common documentation elements associated with specialty injectable drug codes, summarizes relevant policy updates affecting HCPCS drug coding, and highlights operational considerations for claims submission and audits.
This summary is intended for clinicians, billing staff, and policy analysts seeking a national-level reference for HCPCS Level II code Q4174 and its role in outpatient injectable therapy billing.
Billing Code Overview
HCPCS Level II code Q4174 describes Palingen or Promatrx, 0.36 mg per 0.25 cc, a specified formulation of a medication provided in a small-volume injectable preparation. Service type: drug administration / drug supply. Typical site of service: outpatient clinics, ambulatory infusion centers, and physician offices where injectable specialty medications are administered or dispensed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient dermatology clinic or ambulatory surgical center for treatment of actinic keratoses, superficial non-melanoma skin cancers, or localized skin lesions requiring topical or intralesional regenerative/dermal matrix therapy using a product supplied as Q4174 (Palingen or Promatrx, 0.36 mg per 0.25 cc). The workflow includes pre-procedure evaluation, informed consent, lesion mapping and photography, local anesthesia as needed, preparation of the sterile field, and application or injection of the product to the target site. Post-procedure instructions cover wound care, signs of infection or adverse reaction, and scheduled follow-up for assessment of response and potential repeat application. Typical sites of service are outpatient dermatology clinics, ambulatory surgical centers, and physician offices. Patients commonly have comorbidities such as chronic sun damage, prior non-melanoma skin cancer, or impaired wound healing that influence monitoring and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no service modifier applies to the billing for Q4174. |