Q4120 — Matristem burn matrix, per square centimeter
Q4120 is a HCPCS Level II code for matristem burn matrix, per square centimeter. It belongs to the Temporary Codes section. It was terminated on December 31, 2016 and is not valid on new claims.
This code has been terminated
CMS terminated Q4120 on December 31, 2016. It stays in the file as history — a claim you are auditing from before that date may legitimately carry it — but it must not appear on a new claim. The adjacent codes below are the usual place to look for its replacement.
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.
The CMS record for Q4120
- Long descriptor
- Matristem burn matrix, per square centimeter
- Short descriptor
- Matristem burn matrix
- Added
- January 1, 2011
- Terminated
- December 31, 2016
- BETOS
- O1E
- Pricing indicator
- 51 — Other
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.
When CMS retired it.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to Q4120
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q4120 is not quite right, the correct code is very often within a few positions of it.
- Q4112Cymetra, injectable, 1 cc
- Q4113Graftjacket xpress, injectable, 1 cc
- Q4114Integra flowable wound matrix, injectable, 1 cc
- Q4115Alloskin, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4116Alloderm, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4117Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4118Matristem micromatrix, 1 mg
- Q4119Matristem wound matrix, per square centimeterterminated
- Q4121Theraskin, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4122Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4123Alloskin rt, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4124Oasis ultra tri-layer wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4125Arthroflex, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4126Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4127Talymed, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4128Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure)
Questions about Q4120
What is HCPCS code Q4120?
Q4120 is a HCPCS Level II code for matristem burn matrix, per square centimeter. It sits in the Temporary Codes section.
Does Medicare cover Q4120?
The CMS HCPCS file marks Q4120 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.
Is Q4120 still valid?
No. Q4120 was terminated on December 31, 2016 and should not be used on new claims.