Summary & Overview
HCPCS C9356: Tendon Protector Sheet (Porous Collagen/GAG Matrix)
HCPCS Level II code C9356 represents a porous, cross-linked collagen and glycosaminoglycan tendon protector sheet (Tenoglide) billed per square centimeter. The code identifies an implantable biologic device used in tendon repair and reconstruction surgeries to reduce adhesion formation and support tendon gliding. Nationally, coding for biologic tendon scaffolds is significant because it affects hospital and ambulatory surgical center supply reporting, device utilization tracking, and payment for adjunctive surgical materials.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and what to expect in billing practice for this device. The publication outlines benchmark pricing considerations, common payer coverage patterns, and relevant coding relationships that influence reimbursement workflows.
This summary provides clinical and administrative context to aid billing managers, clinicians, and revenue leaders in understanding where C9356 fits in surgical supply coding. Data not available in the input is noted where applicable; the piece focuses on national implications rather than state-level policy differences.
Billing Code Overview
HCPCS Level II code C9356 describes a tendon protector sheet composed of a porous matrix of cross-linked collagen and glycosaminoglycan (branded as Tenoglide), billed per square centimeter. The product is intended for use as a biologic implant to protect or support tendon tissue during surgical procedures involving tendon repair or reconstruction.
Service type: Implantable biologic/tissue scaffold for tendon protection
Typical site of service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with a complex flexor tendon injury or degenerative tendon condition of the hand or wrist requiring augmentation during repair. The surgeon performs open tendon repair and applies a porous, cross-linked collagen and glycosaminoglycan matrix tendon protector sheet (C9356) sized and billed per square centimeter to reinforce the repair, limit adhesions, and provide a biologic scaffold. The workflow: preoperative evaluation in the orthopedic or hand surgery clinic (history, exam, imaging such as ultrasound or MRI), informed consent including implant use, intraoperative open repair of the injured tendon under regional or general anesthesia in an operating room or ambulatory surgical center, placement and suturing of the tendon protector sheet to the repair site, wound closure, postoperative hand therapy referral, and follow-up visits for wound check and range-of-motion progression. Typical site of service is an operating room in a hospital outpatient department or ambulatory surgery center for hand/orthopedic procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the primary procedure (document justification). |