Summary & Overview
HCPCS Q4116: Alloderm Dermal Graft, Per Square Centimeter
HCPCS Level II code Q4116 denotes billing for Alloderm, an acellular dermal matrix product, billed per square centimeter as an add-on supply to a primary surgical procedure. This code matters nationally because implantable biologic supplies like Alloderm are commonly used in reconstructive and soft-tissue procedures and can materially affect episode costs and coverage determinations.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context and use cases, typical sites of service, and the payer landscape that influences coverage and payment. The publication summarizes benchmarks for utilization and reimbursement where available, highlights relevant policy considerations for add-on supply coding, and outlines common modifier usage patterns and billing practice implications. Data not available in the input is noted where applicable. The content is intended to help coding professionals, billing managers, and policy analysts understand HCPCS Level II code Q4116 and its role in surgical supply billing.
Billing Code Overview
HCPCS Level II code Q4116 represents Alloderm billed per square centimeter as an add-on supply item to be listed separately in addition to the primary procedure. The code is used when portions of acellular dermal matrix material branded as Alloderm are supplied and billed based on the area provided.
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Service type: Implantable biologic/dermal graft supply
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Typical site of service: Surgical settings where soft-tissue repair or reconstruction occurs, including hospital operating rooms and ambulatory surgical centers
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult undergoing soft-tissue reconstruction or revision after skin loss, scarring, burn injury, or breast reconstruction where an acellular dermal matrix product (AlloDerm) is used as an adjunct to the primary surgical procedure. Example: a 52-year-old woman undergoing immediate tissue expander placement and implant-based breast reconstruction following mastectomy. Intraoperatively the surgeon places an acellular dermal matrix patch to provide inferior-pole coverage and support for the implant; billing includes the primary reconstruction CPT code(s) plus the add-on Q4116 billed per square centimeter for AlloDerm used. Typical clinical workflow: preoperative planning and informed consent for reconstruction; mastectomy or revision procedure; measurement of AlloDerm graft area; implantation and fixation of AlloDerm to native tissue; intraoperative documentation of square centimeters used; application of appropriate modifiers for bilateral or staged procedures; postoperative monitoring for graft integration, seroma, infection, or need for revision.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when the primary procedure is performed on both sides and payer requires bilateral indicator for add-on material usage in bilateral reconstruction. |