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    v1.0.31
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4124-oasis-ultra-tri-layer-wound-matrix-per-cm
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    HCPCS Level II Q4124: Oasis Ultra Tri-Layer Wound Matrix, per cm2

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4124 describes billing for the Oasis ultra tri-layer wound matrix supplied per square centimeter as an add-on product used in wound care procedures; this code applies to a medical supply/service provided during wound treatment, typically used in outpatient wound clinics, hospital outpatient departments, or other outpatient settings where advanced wound care products are applied and billed separately from the primary procedure.

    For related coverage guidance, see recent payer policy updates: Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatment, HIV/AIDS Pharmacologic Prevention and Treatment, Long-Acting Injectable Antiretroviral Agents for HIV.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with a chronic, nonhealing lower extremity wound — for example, a diabetic foot ulcer or a full‑thickness venous stasis ulcer — refractory to standard wound care (debridement, offloading/compression, topical dressings) over several weeks. The wound care specialist evaluates wound size, depth, infection status, vascular supply, and comorbidities. After appropriate debridement and control of infection and ischemia, the clinician selects a biologic wound matrix such as Q4124 (Oasis ultra tri-layer wound matrix, billed per square centimeter as an add‑on) to provide a scaffold for granulation and epithelialization.

    Workflow: the patient presents to an outpatient wound clinic or hospital outpatient department; wound bed preparation and debridement are performed; measurements of surface area in square centimeters are documented; and Q4124 is applied to the prepared wound and secured. Post‑application wound care and dressing changes are scheduled, with documentation of size measurements and clinical response to justify per‑cm billing. Typical sites of service include outpatient wound care clinics, hospital outpatient departments, and occasionally inpatient settings when wound management is part of an inpatient stay. Common concomitant services include wound debridement, application of primary dressings, and evaluation/management visits.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue; first 20 sq cm or lessOften performed immediately prior to application of Q4124 to prepare a viable wound bed.
    11043Debridement, muscle and/or fascia; first 20 sq cm or lessUsed for deeper wound bed preparation when muscle/fascia debridement is required before matrix placement.
    97597Debridement (e.g., high pressure waterjet, sharp) of open wounds, selective debridement, without anesthesia; first 20 sq cm or lessOutpatient selective debridement that may precede matrix application in clinic.
    15271Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or lessRepresents the procedure of placing a biologic skin substitute and is clinically analogous when larger surface areas are treated with Q4124 billed per cm.
    11044Debridement, bone; first 20 sq cm or lessPerformed when osseous debridement is necessary prior to applying a wound matrix in cases with exposed or infected bone.
    97606Negative pressure wound therapy (NPWT) supply kit; used with NPWTOften applied after placement of a wound matrix to promote graft adherence and wound healing.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207NP0225X
    315P00000X
    132700000X
    103TM1700X
    207QB0002X
    207RM1200X
    246QL0901X
    103TC1900X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    E10.621Type 1 diabetes mellitus with foot ulcer
    E10.622Type 1 diabetes mellitus with other skin ulcer
    E11.621Type 2 diabetes mellitus with foot ulcer
    E11.622Type 2 diabetes mellitus with other skin ulcer
    E88.9Metabolic disorder, unspecified
    I83.019Varicose veins of right lower extremity with ulcer of unspecified site
    I83.219Varicose veins of right lower extremity with both ulcer of unspecified site and inflammation
    I87.2Venous insufficiency (chronic) (peripheral)
    K76.89Other specified diseases of liver
    L03.116Cellulitis of left lower limb

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    HIV/AIDS Pharmacologic Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

    HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

    HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

    HCPCS Level II Q5132: Injection, adalimumab-afzb (Abrilada), 10 mg

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

    HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

    HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

    HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

    HCPCS Q0085: Chemotherapy Infusion Plus Other Technique(s), Per Visit

    HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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