Summary & Overview
HCPCS Q4118: Matristem micromatrix, 1 mg
HCPCS Level II code Q4118 designates Matristem micromatrix, 1 mg — an amniotic membrane–derived biologic used in tissue regeneration and wound care. Nationally, products billed under this HCPCS code are relevant to providers delivering advanced wound management, outpatient surgical grafting, and specialty regenerative procedures. The code matters because it standardizes reporting for a growing class of biologic grafts, enabling consistent billing, utilization tracking, and payment policy development across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of Matristem micromatrix, expected sites of service, and the administrative implications of billing with HCPCS Level II code Q4118. The publication summarizes reimbursement benchmarks where available, common billing practices, and relevant policy considerations that affect coverage and claims processing for amniotic membrane–derived biologics.
This summary equips readers with the essential information needed to interpret how Q4118 is used in clinical billing workflows, what to expect from major national payers, and which operational topics warrant further review (coverage criteria, documentation expectations, and billing consistency). Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code Q4118 represents Matristem micromatrix, 1 mg, a biologic micromatrix derived from amniotic membrane allograft intended for regenerative and wound care applications. The service type is biologic/amniotic membrane graft application, typically used in outpatient surgical settings, wound care clinics, and specialty offices where grafting or tissue regeneration procedures are performed.
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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 or a full-thickness traumatic wound) who presents to an outpatient wound care clinic or ambulatory surgery center for advanced biologic graft therapy. The clinician assesses wound size, depth, infection status, vascular supply, and prior treatments. After debridement and infection control, the provider selects a micromatrix placental-derived product Q4118 (Matristem micromatrix, 1 mg) to promote granulation and re-epithelialization. The procedure workflow includes sterile wound bed preparation, measurement and documentation of wound dimensions, possible local anesthesia, application of the micromatrix to the wound bed, securement with appropriate dressings, and patient education on offloading and dressing care. Typical sites of service are outpatient wound care centers, physician offices with wound care capability, ambulatory surgical centers, and hospital outpatient departments. Follow-up visits document healing progress, need for additional applications, and any complications such as infection or allergic reaction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Reserved (not typically used clinically) | Data not applicable for clinical billing use; follow payer guidance. |