Summary & Overview
HCPCS Level II C9363: Integra Meshed Bilayer Wound Matrix, Per cm²
HCPCS Level II code C9363 designates the Integra meshed bilayer wound matrix billed per square centimeter. This code captures the use of a biologic skin substitute product employed to promote dermal regeneration in complex or full-thickness wounds. Nationally, devices and biologic materials billed under distinct HCPCS codes are important drivers of advanced wound care costs and utilization, and accurate coding affects coverage determination and claims processing.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical indication and service context for this skin substitute, followed by benchmarks and coverage considerations commonly assessed by these payers. The publication summarizes available national pricing and utilization benchmarks where available, highlights recent policy and coverage updates that affect skin substitute billing, and outlines coding and billing nuances specific to HCPCS Level II product codes.
This report is intended to inform billing, coding, and compliance teams, as well as clinical leaders involved in wound care procurement and utilization management. It focuses on the clinical context of use, payer coverage patterns, reimbursement benchmarks, and policy developments relevant to HCPCS Level II code C9363 at a national level.
Billing Code Overview
HCPCS Level II code C9363 describes a skin substitute, Integra meshed bilayer wound matrix, per square centimeter. This code represents a biologic wound care product used as a skin substitute to support soft-tissue regeneration in full-thickness wounds and other complex dermal defects.
Service Type: skin substitute / biologic wound matrix application
Typical Site of Service: inpatient or outpatient surgical settings, wound care clinics, and specialty centers where grafting or advanced wound therapies are performed
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a chronic, non-healing full-thickness lower extremity wound present for several months after failed conservative care is evaluated in an outpatient wound care clinic. The wound measures 30 cm2 after debridement and manifests exposed subcutaneous tissue without active deep infection. The multidisciplinary team (vascular surgery, podiatry, or plastic surgery) confirms adequate vascular supply and optimizes medical comorbidities (glycemic control, offloading, infection control). During the operative or procedural encounter, after surgical debridement and hemostasis, a skin substitute product, specifically C9363 (Integra meshed bilayer wound matrix, per square centimeter), is applied to the wound bed and secured per product instructions. The procedure may occur in an operating room, ambulatory surgery center, or specialized procedure room depending on patient complexity and anesthesia needs. Post-application care includes dressing changes, monitoring for graft integration, and follow-up visits to assess incorporation and need for additional applications or definitive closure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to apply the skin substitute substantially exceeds typical effort due to extensive debridement, complex anatomy, or prolonged operative time. |