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    v1.0.30
    OpenPayerBilling CodesMatrix for Wound Management (Placental, Equine, Synthetic)HCPCS hcpcs-a2004-xcellistem-1mg-specialty-biologic-supply
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    HCPCS A2004: Xcellistem, 1 mg

    HCPCS Level II code A2004 represents billing for Xcellistem, 1 mg, an advanced biologic product typically administered as an injectable cell-based therapy; service type: biologic cell therapy administration; typical site of service: infusion center or outpatient clinic. Data not available in the input.

    For related coverage guidance, see recent payer policy updates: Breast Reduction (Mammoplasty) Surgery, Rhinoplasty Medical Necessity and Site of Service, Surgical Treatments for Lymphedema.

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with a history of progressive ischemic cardiomyopathy and refractory heart failure receives a subcutaneous injection of A2004 (Xcellistem, 1 mg) as part of a cell-based biologic therapy regimen. The patient presents to an outpatient infusion clinic or ambulatory surgical center for administration. The clinical workflow includes pre-procedure review of indications and allergies, informed consent, baseline vital signs and cardiac monitoring, preparation of the product under aseptic technique by pharmacy or trained staff, verification of product dose and patient identity, administration via subcutaneous or intramuscular injection depending on manufacturer instructions, a 30–60 minute post-injection observation period for immediate adverse reactions, and documentation of lot number, dosage, route, site, and any immediate adverse events in the medical record. Typical sites of service are outpatient infusion centers, ambulatory surgical centers, physician offices with appropriate credentialing, or hospital outpatient departments. Payors commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularCommon code for the actual subcutaneous administration of A2004 when billed separately from the product HCPCS code
    96401Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplasticUsed when administration techniques align with chemotherapy-style biologic injections and payer rules require this code for biologic cellular products
    36415Collection of venous blood by venipuncturePerformed before administration for baseline labs, infectious disease screening, or biomarker monitoring
    99024Postoperative follow-up visit global; minor or major surgeryBilling for routine postoperative or post-administration follow-up visits when included in a global period for a related procedure
    99070Supplies and materials (except spectacles), provided by physician over and above those usually included with the serviceUsed for non-routine supplies directly related to preparation or administration of the biologic product

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    363L00000X
    208000000X
    261QG0250X
    261QM1103X
    1835P0018X
    1041C0700X
    225XN1300X

    Related Payer Policy Updates

    Specialty: Plastic/Reconstructive Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Breast Reduction (Mammoplasty) SurgeryKaiser Permanente2027-02-01
    Rhinoplasty Medical Necessity and Site of ServicePremera Bluecross2026-10-14
    Surgical Treatments for LymphedemaProvidence Health Plan2026-10-01
    Surgical Treatment of Lipedema and LymphedemaPremera Bluecross2026-10-01
    Breast Reduction Surgery (for North Carolina Only)UnitedHealthcare2026-10-01
    Cosmetic, Reconstructive, or Plastic SurgeryUnitedHealthcare2026-10-01
    Surgical Treatments for LymphedemaProvidence Health Plan2026-10-01
    Reduction Mammoplasty (Breast Reduction Surgery) for Symptomatic MacromastiaWPS Health Insurance2026-10-01
    Reduction MammoplastyModa Health2026-10-01
    Treatment for Lipedema (Lipectomy/Liposuction)Moda Health2026-10-01

    Related Codes

    HCPCS-A2001-INNOVAMATRIX-PER-SQ-CM

    HCPCS Level II A2001: Innovamatrix ac, per square centimeter (add-on)

    HCPCS-A2002-MIRRAGEN-ADVANCED-WOUND-MATRIX-PER-CM2

    HCPCS Level II A2002: Mirragen Advanced Wound Matrix, per sq cm

    HCPCS-A2005-MICROLYTE-MATRIX-WOUND-BIOMATERIAL-PER-CM2

    HCPCS Level II A2005: Microlyte Matrix, Per Square Centimeter

    HCPCS-A2006-NOVOSORB-DERMAL-MATRIX-PER-CM

    HCPCS A2006: Novosorb Synpath Dermal Matrix, per cm2

    HCPCS-A2007-RESTRATA-PER-SQ-CM-TOPICAL-WOUND-MATERIAL

    HCPCS Level II A2007: Restrata, per Square Centimeter (Add-on)

    HCPCS-A2008-THERAGENESIS-PER-SQUARE-CENTIMETER-ADD-ON

    HCPCS Level II A2008: Theragenesis, Per Square Centimeter

    HCPCS-A2009-SYMPHONY-PER-SQUARE-CENTIMETER-ADD-ON

    HCPCS Level II A2009: Symphony, per Square Centimeter (Add-on)

    HCPCS-A2010-APIS-PER-SQUARE-CENTIMETER-TOPICAL-BIOLOGIC-ADD-ON

    HCPCS Level II A2010: Apis Topical Product Per Square Centimeter

    HCPCS-A2011-SUPRA-SDRM-PER-SQ-CM-ADD-ON

    HCPCS Level II A2011: Suprasdrm per Square Centimeter (Add-on)

    HCPCS-A2012-SUPRATHEL-PER-SQUARE-CENTIMETER

    HCPCS A2012: Suprathel Skin Substitute, Per cm2

    Showing 1–10 of 43

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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