HCPCS Level II Q4139: Injectable Amniomatrix or Biodmatrix, 1 cc
HCPCS Level II code Q4139 designates an injectable amniomatrix or biodmatrix, 1 cc, used as a small-volume biologic scaffold to support tissue repair and regeneration. Nationally, this code matters because it identifies the product for billing and coverage decisions in procedures that leverage biologic matrices, and it influences payer coverage, site-of-service considerations, and clinical documentation requirements.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical coverage considerations, common sites of service where this injectable is used, and the clinical context in which a 1 cc amniomatrix or biodmatrix is applied. The publication summarizes benchmark payment approaches, likely documentation expectations, and potential policy updates affecting biologic injectable products.
This analysis provides clinicians, billers, and policy stakeholders with concise benchmarks and policy context to inform billing practices and payer discussions. Data not available in the input is noted where applicable; the focus remains on the code definition, clinical use, and payer coverage landscape at a national level.
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Billing Code Overview
HCPCS Level II code Q4139 describes an injectable amniomatrix or biodmatrix, 1 cc. This product is a biologic matrix intended for injection to support tissue repair or regeneration in procedures that require delivery of a small-volume biologic scaffold.
Service type: Injectable biologic matrix for tissue repair/regeneration
Typical site of service: Ambulatory surgical centers, hospital outpatient departments, physician office procedures, or other outpatient settings where injectable biologic products are administered
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic, non-healing soft-tissue wound (for example, a diabetic foot ulcer, venous stasis ulcer, or pressure ulcer) evaluated in an outpatient wound care clinic or hospital-based clinic. The wound care team—often including a podiatrist, wound care physician, or plastic surgeon—performs standard wound assessment, debridement as needed, and cleansing. After preparing the wound bed and confirming suitability (adequate vascular supply, infection control), the clinician injects or places an amniotic-derived injectable matrix product (Q4139, amniomatrix or biodmatrix, injectable, 1 cc) into the wound base or surrounding soft tissue to support biological wound healing. The procedure typically occurs under local anesthesia in an office procedure room, ambulatory surgery center, or inpatient bedside when indicated. Documentation includes wound measurements, description of debridement, indication for biologic matrix, amount administered (number of Q4139 units), anesthesia used, and post-procedure wound care instructions. Follow-up visits document healing progress and any complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required is substantially greater than usual for the injectable placement (extensive debridement or additional time). |
23 | Unusual anesthesia | When general anesthesia or deep sedation is medically necessary for the injectable placement in an otherwise non-anesthesia procedure. |
52 | Reduced services | When the injectable treatment is partially performed or less than full described service is provided. |
53 | Discontinued procedure | When the procedure is started but halted due to a complication or safety concern before administering the biologic. |
54 | Surgical care only | When another clinician provides only the surgical procedure (e.g., debridement and placement of the injectable) and not pre/post-op care. |
55 | Post-operative management only | When another clinician provides only follow-up care after initial placement of the injectable. |
56 | Pre-operative management only | When another clinician provides pre-op evaluation but not the procedure. |
62 | Two surgeons | When two surgeons are required to perform the procedure for technical reasons (rare for injectable placement). |
73 | Discontinued outpatient hospital/ASC procedure prior to anesthesia | When procedure is stopped before anesthesia administration in the ambulatory setting. |
80 | Assistant surgeon | When an assistant surgeon is documented as participating in the procedure. |
82 | Assistant surgeon (when qualified resident unavailable) | When an assistant surgeon is needed and no qualified resident is available. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service | When a qualified non-physician practitioner furnishes the injectable procedure per state scope of practice. |
QX | CRNA service with medical direction by physician | When a nurse anesthetist provides anesthesia under physician direction for the procedure. |
QY | Medical direction of two, three, or four concurrent anesthesia procedures | When a physician directs multiple concurrent anesthesia services that include this procedure. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080S00000X | Podiatry | Common for diabetic foot ulcer assessment and injectable matrix placement. |
207L00000X | Plastic Surgery | Used when complex soft-tissue reconstruction or biologic augmentation is performed. |
208000000X | Family Medicine | Wound care clinics within primary care may perform bedside injectable placements. |
207K00000X | General Surgery | Surgeons may use injectable biologic matrices in debridement and wound management. |
363LF0000X | Wound Care Specialist | Clinicians focusing on wound care management frequently perform these treatments. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E11.621 | Type 2 diabetes mellitus with foot ulcer | Common indication for biologic injectable matrix to promote healing of diabetic foot ulcers. |
L97.421 | Non-pressure chronic ulcer of right calf limited to breakdown of skin | Representative of chronic lower-extremity ulcers treated with biologic matrices. |
L97.429 | Non-pressure chronic ulcer of left calf limited to breakdown of skin | Same clinical relevance for the contralateral limb. |
I83.013 | Varicose veins of right lower extremity with ulcer, recurrent | Venous stasis ulcers often receive advanced wound therapies including biologic matrices. |
M86.17 | Chronic osteomyelitis, right tibia and fibula | When underlying bone infection is controlled, injectable matrices may be used adjunctively after debridement. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11042 | Debridement, subcutaneous tissue (eg, carbuncle, postsurgical wound), first 20 sq cm or less | Often performed immediately before injectable biologic placement to prepare the wound bed. |
11043 | Debridement, muscle and/or fascia, first 20 sq cm or less | Used when deeper infected or necrotic tissue requires removal prior to matrix placement. |
11044 | Debridement, bone (eg, osteomyelitis), first 20 sq cm or less | Applicable when bony involvement is present and needs debridement before application of the injectable matrix. |
29581 | Application of multilayer compression, short stretch bandage, including training | Often performed after injectable placement for venous stasis ulcers as part of off-loading and compression therapy. |
97605 | Negative pressure wound therapy (NPWT) application, first 48 hours | May be used before or after injectable placement as part of advanced wound management strategy. |