Summary & Overview
HCPCS Q4133: Placental Allograft (Grafix/Stravix), per sq cm
HCPCS Level II code Q4133 designates the per-square-centimeter supply of placental-derived allograft products — marketed as Grafix prime, GrafixPL prime, Stravix, and StravixPL — billed as an add-on in addition to a primary procedure. These advanced biologic grafts are used as wound-healing adjuncts for complex or nonhealing wounds and are relevant to clinicians, facility billing teams, and payers managing wound-care pathways. Nationally, use of such allografts affects outpatient wound-care costs and coverage determinations due to product-specific pricing and clinical evidence requirements.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and typical settings, plus benchmarking context and payer coverage considerations. The publication summarizes payment and coding considerations relevant to facilities and clinicians that apply placental allografts, highlights common modifiers and billing practices (listed separately), and outlines where to find related codes and documentation expectations. Data not available in the input are noted where applicable. This resource is intended to inform billing staff, clinical program leads, and policy analysts about the code’s role in wound care and common administrative points to address when submitting claims nationally.
Billing Code Overview
HCPCS Level II code Q4133 describes application of human tissue allograft products marketed as Grafix prime, GrafixPL prime, Stravix, and StravixPL, billed per square centimeter as an add-on, list separately in addition to primary procedure. The code denotes the supply of these engineered placental tissue grafts used to promote wound healing in settings where such biologic grafts are applied to a wound bed.
Service type: Biologic tissue graft supply / wound care adjunct
Typical site of service: Outpatient wound care settings, hospital outpatient departments, ambulatory surgical centers, and specialty clinics that perform wound debridement and graft application
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic nonhealing lower extremity ulcer (for example, a diabetic foot ulcer or venous stasis ulcer) who has failed standard wound care including debridement, offloading, and topical therapies. The wound care specialist or podiatrist evaluates the wound in an outpatient clinic or ambulatory wound center. After sharp debridement and preparation of the wound bed to remove nonviable tissue and reduce bioburden, the clinician measures the wound and selects a single-layer placental membrane allograft product such as Q4133 (Grafix Prime, GrafixPL Prime, Stravix, StravixPL) to be applied per square centimeter as an adjunctive biologic graft.
The clinical workflow includes wound assessment and staging, informed consent, wound bed preparation (sharp debridement and hemostasis), application of the allograft sized to the wound, securement with appropriate dressings (and possibly negative pressure wound therapy), and scheduling of follow-up visits for graft take assessment and repeat applications if needed. This code is billed as an add-on, separately from primary surgical or debridement procedure codes, and charged per square centimeter of graft used. Typical sites of service are outpatient wound care clinics, ambulatory surgical centers, and hospital outpatient departments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services |