Policy library / Q4104 Commercial payer policies listing Q4104 9 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Ambetter policies listing Q4104, with the code’s status in each Policy Effective Status of Q4104 Burn Surgery PayerPolicy · AMBETTER-CP-MP-186 Not recorded Covered Skin and Soft Tissue Substitutes PayerPolicy · AMBETTER-CP-MP-185 Not recorded Covered
Humana policies listing Q4104, with the code’s status in each Policy Effective Status of Q4104 Skin and Tissue Substitutes PayerPolicy · HUMANA-SKIN-AND-TISSUE-SUBSTITUTES-MA Sep 1, 2026 Covered Skin and Tissue Substitutes PayerPolicy · HUMANA-SKIN-AND-TISSUE-SUBSTITUTES-VA-MEDICAID May 27, 2026 Covered
Anthem policies listing Q4104, with the code’s status in each Policy Effective Status of Q4104