HCPCS Q4146 is officially defined as "Tensix, per square centimeter (add-on, list separately in addition to primary procedure)." HCPCS Q4146 is referenced in 3 tracked payer policy changes from Sentara Health Plans, Humana, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q4146 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Humana's revised Kentucky Medicaid policy on skin and tissue substitutes lists the only covered uses as diabetic foot ulcers and venous leg ulcers that have lasted more than 4 weeks, when standard wound care criteria are met, and states that prior authorization is required. The policy lists many HCPCS codes for these products as requiring prior authorization for Humana Healthy Horizons members in Kentucky. The source gives an effective date of 08/12/2026, and the code list in the provided text is cut off near the end.
Several listed tissue-engineered skin substitutes may be considered medically necessary for specific uses, including breast reconstruction with listed acellular dermal matrix products, chronic noninfected full-thickness diabetic lower-extremity ulcers, chronic venous insufficiency ulcers that have not adequately responded to a 1-month period of conventional ulcer therapy, dystrophic epidermolysis bullosa, and second- and third-degree burns. All other uses of the listed products, and all other skin and soft tissue substitutes not listed, are considered investigational. Code reference updates dated 07/01/2026, 08/15/2026 and 10/01/2026 add CPT 1045T through 1049T, HCPCS C9353 and C9361, and HCPCS A2046, A2047, A2048 and A2050 as investigational codes.
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