HCPCS C9364: Porcine Implant (Permacol) Per Square Centimeter - OpenPayer

Summary & Overview

HCPCS C9364: Porcine Implant (Permacol) Per Square Centimeter

HCPCS Level II code C9364 designates a porcine-derived implant (Permacol) billed by square centimeter for use in tissue reinforcement and reconstructive surgical procedures. Nationally, use of biologic implants like Permacol affects surgical supply costs, coding specificity, and payer coverage determinations because they are billed by area and can vary substantially by procedure complexity and quantity required. Clear coding is important for accurate supply accounting and claims adjudication.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for porcine-derived biologic implants, common settings where the product is used, and the implications of billing by unit area. The publication also summarizes benchmarks for utilization and coverage themes, highlights relevant policy updates that affect implant supply coding, and outlines considerations for claims documentation and reimbursement workflows. Where input data was not provided, the text notes that specific payer policy details, associated taxonomies, and ICD-10 diagnoses are not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9364HCPCS Level IIporcine implantPermacolbiologic implantsurgical suppliesreconstructive surgeryambulatory surgeryhospital billing

Billing Code Overview

HCPCS Level II code C9364 represents a porcine implant (Permacol) billed per square centimeter. This code is used for biologic implant material derived from porcine sources (Permacol) measured and billed by surface area.

Service type: Implantation of porcine-derived biologic matrix material used in tissue reinforcement, reconstructive or surgical repair procedures
Typical site of service: Hospital operating room, ambulatory surgery center, or inpatient surgical settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an outpatient surgical clinic or ambulatory surgery center with a chronic, non-healing soft-tissue defect or abdominal wall reinforcement need following tumor resection, wound debridement, or complex hernia repair. The surgeon plans placement of a porcine-derived acellular dermal matrix (Permacol) graft, billed per square centimeter with C9364, to provide biologic scaffold for tissue ingrowth, reinforcement of soft tissues, or to support mesh repair in contaminated fields. Preoperative evaluation includes wound assessment, review of prior surgeries and comorbidities (e.g., diabetes, smoking, immunosuppression), and informed consent discussing biologic implant use. The procedure typically occurs in an operating room or ambulatory surgery center under general or regional anesthesia. Intraoperative steps include meticulous debridement of nonviable tissue, measurement of the defect to determine graft size (documented in square centimeters for C9364 billing), tailoring of the porcine implant to fit the defect, secure fixation to surrounding tissues, and layered closure when feasible. Postoperative workflow includes wound care instructions, antibiotic management if indicated, follow-up visits to monitor graft incorporation and wound healing, and documentation of implant size and lot/serial number in the operative record for implant tracking and billing reconciliation.

Coding Specifications

Modifier	Description	When to Use

HCPCS C9098: Ciltacabtagene Autoleucel, BCMA-Directed CAR T Therapy

HCPCS-C9157-TOFERSEN-INJECTION-1MG

HCPCS C9157: Injection, tofersen, 1 mg

HCPCS-C2698-BRACHYTHERAPY-STRANDED-SOURCE-PER-SOURCE

HCPCS C2698: Brachytherapy Stranded Source, Per Source

HCPCS-C9026-VEDOLIZUMAB-INJECTION-1MG

HCPCS C9026: Injection, Vedolizumab, 1 mg

HCPCS-C5277-LOW-COST-SKIN-SUBSTITUTE-GRAFT-LARGE-WOUND-SURFACE-AREA

HCPCS C5277: Low Cost Skin Substitute Graft Application, ≥100 sq cm

HCPCS-C5271-LOW-COST-SKIN-SUBSTITUTE-GRAFT-TRUNK-ARMS-LEGS-25SQCM

HCPCS C5271: Low-Cost Skin Substitute Graft Application, ≤25 sq cm

HCPCS-C1762-CONNECTIVE-TISSUE-HUMAN-FASCIA-LATA

HCPCS C1762: Connective Tissue, Human (Includes Fascia Lata)

HCPCS-C9740-CYSTOURETHROSCOPY-TRANSPROSTATIC-IMPLANT-4-PLUS

HCPCS C9740: Cystourethroscopy with Transprostatic Implants, 4+

HCPCS-C9813-PERFORATED-CONTINUOUS-INFUSION-CATHETER-NON-OPIOID-DEVICE

HCPCS C9813: Perforated Continuous Infusion Catheter Set, Non-Opioid Device

HCPCS-C2642-CESIUM-131-BRACHYTHERAPY-SOURCE-STRANDED

HCPCS C2642: Brachytherapy Source, Cesium-131, Stranded

Showing 1–10 of 603

22

Taxonomy Code	Specialty	Notes
`207L00000X`	General Surgery	Most common specialty performing complex wound reconstruction and abdominal wall repair with biologic implants.
`2080P0002X`	Plastic Surgery	Performs soft-tissue reconstruction, complex wound coverage, and porcine dermal matrix placement for contour and coverage.
`2086S0123X`	Surgical Oncology	Uses biologic implants for chest wall or abdominal defects after tumor resections.
`2084P0800X`	Colon & Rectal Surgery	Uses implants for perineal or pelvic floor reconstructions and contaminated-field hernia repairs.
`208D00000X`	General Practice (Wound Care Surgery focus)	Providers focused on complex wound management and reconstructive procedures in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K43.2`	Incisional hernia without obstruction or gangrene	Used when a porcine implant reinforces abdominal wall repair for incisional hernia in contaminated or high-risk fields.
`L89.309`	Pressure ulcer of sacral region, unspecified stage	Biologic matrices are used to reconstruct chronic pressure wounds after debridement.
`T81.4XXA`	Infection following a procedure, initial encounter	Relevant when porcine implants are placed to manage or aftercare of infected surgical sites; also relevant if explantation later required.
`L97.411`	Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed	Chronic lower-extremity non-healing ulcers may be reconstructed using biologic dermal matrices.
`C49.A09`	Soft tissue sarcoma of abdomen, pelvis and trunk, unspecified	After oncologic resection, porcine implants may be used for soft-tissue or fascial reconstruction.
`S31.01XA`	Open wound of abdomen, initial encounter	Traumatic abdominal wall defects may be repaired with biologic implants when contamination is present.
`K91.89`	Other complications of alimentary tract, not elsewhere classified	Used for postoperative abdominal wall complications requiring reinforcement with biologic grafts.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11043`	Debridement, muscle and/or fascia (first 20 sq cm or less)	Often performed before placement of the porcine implant to remove nonviable tissue and prepare the wound bed.
`15734`	Muscle, myocutaneous or fasciocutaneous flap; trunk	May be performed in conjunction with biologic implant placement for large or complex defects requiring vascularized tissue coverage.
`49568`	Mesh implantation for open ventral or incisional hernia repair, with or without component separation; each additional component (list separately in addition to primary procedure)	Biologic grafts like Permacol may be used as an alternative or adjunct to synthetic mesh in contaminated or high-risk fields.
`15271`	Application of skin substitute graft to trunk, arms, legs (includes dressings)	When biologic dermal matrices are used for soft tissue reinforcement or coverage in conjunction with grafting procedures.
`12032`	Repair, intermediate, wounds of scalp, arms, or legs; 2.6 cm to 7.5 cm	Smaller wound closures after implant placement may be reported with appropriate wound repair codes when closure is performed.
`20680`	Removal of implanted soft tissue foreign body, deep (eg, tumor excision with implant removal)	May be used if a previously placed porcine implant requires explantation due to infection or failure.

OpenPayer