Q4202 Keroxx (HCPCS) Reimbursement & Benchmarks

HCPCS Level II code Q4202 identifies Keroxx (2.5 g/cc), 1 cc — an ophthalmic viscoelastic device used as a surgical supply in intraocular procedures. This code matters nationally because viscoelastic agents are essential consumables in cataract and anterior segment surgeries; consistent coding supports accurate billing, inventory management, and comparative analyses across payers and facilities.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for Q4202, the typical sites of service where this product is used, and the role the code plays in surgical supply billing. The publication outlines what is known about payer coverage patterns and common modifiers associated with surgical supplies, and it highlights benchmarks and policy issues relevant to medical device supply codes.

The report provides operationally useful information for revenue cycle, surgical service managers, and compliance teams: how this HCPCS Level II code maps to intraoperative use, where it is billed (hospital outpatient departments and ambulatory surgery centers), and which large payers to consider when preparing claims or reviewing coverage. Data not available in the input is noted where applicable.

Billing Code Overview

HCPCS Level II code Q4202 describes Keroxx (2.5g/cc), 1cc, an ophthalmic viscoelastic device supplied as a 1 cc unit of 2.5 g/cc formulation. The service type is ophthalmic surgical supply used during intraocular procedures such as cataract surgery and other anterior segment interventions. The typical site of service is hospital outpatient departments and ambulatory surgery centers, and it is used intraoperatively to maintain anterior chamber depth, protect intraocular tissues, and facilitate surgical maneuvers.

Data not available in the input.

Clinical Context

A patient with chronic, focal neuropathic pain or symptomatic soft-tissue cavity defects presents to an outpatient ambulatory surgery center or hospital outpatient department for injection of a sterile, viscous, absorbable hemostatic/adhesive or space-filling implant product sold under the HCPCS Level II code Q4202 (Keroxx 2.5g/cc, 1cc). Typical patients are adults who have had recent surgical debridement, tumor resection, or musculoskeletal procedure resulting in a small dead space requiring a topical filler to support hemostasis and tissue approximation. The clinical workflow includes pre-procedure verification of indication and consent, sterile preparation, administration of local or regional anesthesia (if needed), topical or injectable placement of the Q4202 product into the surgical bed or cavity under direct visualization or image guidance, brief observation for hemostasis and immediate adverse events, and discharge with routine post-procedure wound care instructions. Common sites of service are outpatient ambulatory surgery centers, hospital outpatient departments, and procedure rooms in specialty clinics (e.g., orthopedic, ENT, neurosurgery, or general surgery clinics).

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when work required is substantially greater than typical for placement of a topical implant due to complexity or additional time.

Taxonomy Code	Specialty	Notes
`208000000X`	Surgery - General	General surgeons commonly place topical fillers or hemostatic implants in soft-tissue surgical beds.
`208600000X`	Orthopaedic Surgery	Orthopedic surgeons use space-filling/adhesive implants in joint or musculoskeletal procedures.
`207P00000X`	Surgery - Plastic & Reconstructive	Plastic surgeons place adjunctive implantable products for dead space management and contour.
`2084P0800X`	Otolaryngology	ENT surgeons use topical implants for sinus, skull base, or head/neck cavity management.
`207L00000X`	Neurological Surgery	Neurosurgeons may use small-volume implants in cranial or spinal surgical beds.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T81.89XA`	Other complications of procedures, not elsewhere classified, initial encounter	Used when a patient requires topical implant placement to manage a postoperative complication such as bleeding or persistent dead space.
`S01.81XA`	Laceration without foreign body of other part of head, initial encounter	Relevant when focal soft-tissue defects after trauma are treated with small-volume implants to support hemostasis and tissue approximation.
`M79.2`	Neuralgia and neuritis, unspecified	May be used in scenarios of neuropathic pain management where topical fillers are placed adjacent to neural structures for mechanical support or hemostasis during related procedures.
`I97.89`	Other postprocedural disorders of the circulatory system	Applied when hemostatic adjuncts like `Q4202` are used to address postprocedural bleeding complications.
`L98.4`	Non-healing surgical wound	Used when placement of a topical implant is part of managing a non-healing wound with persistent cavity or dead space.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20550`	Injection(s); single tendon sheath, or ligament, synovial cyst	May be performed prior to or instead of small-volume implant placement for localized soft-tissue pathology or diagnostic therapeutic injections.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	Performed in musculoskeletal workflows where joint aspiration or injection precedes placement of a topical implant in adjacent soft tissues.
`10160`	Puncture aspiration of abscess; simple or single	May be performed when drainage of fluid collection is required before placement of a space-filling implant to manage dead space.
`19318`	Reduction mammaplasty (breast reduction)	Example of a surgical procedure after which small-volume topical implants like `Q4202` may be used to manage dead space or hemostasis (adjunctive use).
`69990`	Microsurgical techniques, requiring use of an operating microscope (list separately in addition to code for primary procedure)	May be used concurrently when precise placement of a small-volume implant is required in microsurgical fields.

OpenPayer

Summary & Overview

HCPCS Level II Q4202: Keroxx (2.5g/cc) 1cc