WebApr 4, 2024 · Q4177 FlowerAmnioFlo®, 0.1 cc Q4178 FlowerAmnioPatch, per sq cm Q4180 Revita®, per sq cm Q4181 Amnio Wound, per sq cm Q4183 SurgiGRAFT™, per square centimeter Q4184 Cellesta™ or Cellesta™ Duo, per square centimeter . Effective Aug. 1 , 2024 . Q4185 Cellesta™ flowable amnion (25 mg per cc); per 0.5 cc ... WebQ4177 FlowerAmnioFlo, 0.1 cc Q4178 FlowerAmnioPatch, per sq cm . 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY 4 (401) 274 …
EFFECTIVE DATE: 0 POLICY LAST UPDATED: 12 - BCBSRI
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Centers for Medicare & Medicaid Services (CMS) …
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