Q4142 Biologic Matrix HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Q4142: Xcm Biologic Tissue Matrix, Per cm² (Add-On)

HCPCS Level II code Q4142 denotes the Xcm biologic tissue matrix, charged per square centimeter as an add-on supply when used alongside a primary surgical procedure. Nationally, add-on implant and biologic supply codes like Q4142 matter because they affect operative supply reporting, procedural cost accounting, and payer payment policies tied to surgical bundles and implant coverage. Payers commonly assessing add-on implant codes include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication outlines how Q4142 is defined and used in clinical practice, and summarizes what readers need to know about coverage and billing considerations at a national level. The report provides benchmark-oriented context on typical use cases and sites of service, describes common modifiers and coding practice (listed separately), and highlights policy areas that influence payment for add-on biologic matrices. Readers will find a concise explanation of the code’s clinical role in operative settings, recommended documentation elements to support reporting, and an overview of payer considerations and frequently seen billing scenarios. Data not available in the input for payer-specific rates, utilization frequencies, and related taxonomies is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4142HCPCS Level IIbiologic tissue matrixsurgical supplyadd-on codeoperative careambulatory surgeryimplantable graft

Billing Code Overview

HCPCS Level II code Q4142 represents the Xcm biologic tissue matrix, billed per square centimeter. This code is an add-on supply code intended to be reported in addition to a primary surgical procedure when the Xcm biologic tissue matrix is implanted or applied.

Service type: Biologic tissue graft/implant supply

Typical site of service: Operative/surgical settings, including inpatient and outpatient hospital operating rooms and ambulatory surgical centers where a primary procedure requiring a biologic tissue matrix is performed.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with a chronic non-healing full-thickness abdominal wall or ventral hernia surgical wound after prior mesh removal for infection. The patient presents to the operating room for definitive closure and reinforcement using a biologic tissue matrix. The procedure is performed as an adjunct to the primary surgical repair (hernia or soft-tissue reconstruction). Intraoperatively, the surgeon measures the area of biologic matrix required in square centimeters and implants the Q4142 product to augment native tissues, enhance soft-tissue support, and reduce tension on suture lines.

Preoperative workflow includes history and physical, assessment of wound and infection risk, optimization of comorbidities (for example diabetes control), and consent addressing use of biologic graft material. Intraoperative workflow includes harvesting or preparing the primary repair (for example hernia defect closure or fascial repair), hemostasis, sizing and trimming the biologic matrix, placement and fixation of the matrix as an onlay/inlay or underlay depending on defect, and documentation of square centimeters of matrix used. Postoperative workflow includes wound care instructions, antibiotic management if indicated, activity restrictions, and follow-up visits to monitor for incorporation, seroma, or infection. Billing is reported using Q4142 as an add-on per square centimeter in addition to the primary operative CPT code for the hernia or soft-tissue repair.

Coding Specifications

Modifier	Description	When to Use

HCPCS Q4134: Hmatrix per Square Centimeter, Add-On Supply

HCPCS-Q4009-SHORT-ARM-PLASTER-CAST-ADULT-SUPPLY

HCPCS Q4009: Short Arm Plaster Cast Supply, Adult

HCPCS-Q4001-BODY-CAST-ADULT-PLASTER

HCPCS Level II Q4001: Casting Supplies, Adult Full-Body Plaster

HCPCS-Q9954-ORAL-MRI-CONTRAST-AGENT-PER-100ML

HCPCS Q9954: Oral Magnetic Resonance Contrast Agent, per 100 ml

HCPCS-Q4340-SIMPLIGRAFT-PER-SQ-CM-SKIN-SUBSTITUTE-ADD-ON

HCPCS Level II Q4340: Simpligraft per Square Centimeter

HCPCS-Q0177-HYDROXYZINE-25MG-ORAL-ANTI-EMETIC-CHEMO-SUBSTITUTE

HCPCS Q0177: Hydroxyzine Pamoate 25 mg Oral Anti‑emetic

HCPCS-Q4154-BIOVANCE-WOUND-MATRIX-PER-SQ-CM

HCPCS Q4154: Biovance Wound Matrix, per Square Centimeter

HCPCS-Q4178-FLOWERAMNIOPATCH-PER-SQ-CM-ADD-ON

HCPCS Level II Q4178: Floweramniopatch, Per Square Centimeter

HCPCS-Q9977-COMPOUNDED-DRUG-NOT-OTHERWISE-CLASSIFIED

HCPCS Q9977: Compounded Drug, Not Otherwise Classified

HCPCS-Q0503-BATTERY-PNEUMATIC-VENTRICULAR-ASSIST-DEVICE-REPLACEMENT

HCPCS Q0503: Battery for Pneumatic Ventricular Assist Device, Replacement

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Taxonomy Code	Specialty	Notes
`207L00000X`	General Surgery	Primary specialty performing hernia repairs and soft-tissue reconstructions using biologic matrices.
`2080P0208X`	Colon and Rectal Surgery	Specialists who commonly manage complex ventral and incisional hernias and may utilize biologic grafts.
`208800000X`	Plastic Surgery	Performs complex soft-tissue reconstructions and abdominal wall reconstruction with biologic matrices.
`207X00000X`	Critical Care Surgery / Trauma Surgery	Manages complex or infected wounds requiring biologic matrix use in contaminated fields.
`2086S0122X`	Surgical Oncology	May use biologic matrices in reconstruction after oncologic resections when soft-tissue support is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K43.2`	Ventral hernia without obstruction or gangrene	Common indication for biologic matrix to reinforce fascial repair in primary ventral hernia.
`K43.3`	Incisional hernia without obstruction or gangrene	Frequent clinical scenario where biologic matrices are used to augment repair and manage poor tissue quality.
`T81.4XXA`	Infection following a procedure, initial encounter	Postoperative infection may necessitate removal of synthetic mesh and use of biologic matrix in contaminated fields.
`L97.909`	Non-pressure chronic ulcer of unspecified part of lower leg, unspecified severity	Chronic non-healing wounds may be treated with biologic matrices as part of layered soft-tissue reconstruction.
`K91.83`	Postprocedural intestinal obstruction	Complex abdominal wall cases with prior surgeries may require biologic reinforcement during reoperation.
`M79.89`	Other specified soft tissue disorders	Captures varied soft-tissue defects where biologic matrix supports reconstruction.
`Z48.21`	Encounter for removal of sutures	Represents postoperative care events related to procedures in which biologic matrix was implanted.
`Z98.890`	Other specified postprocedural states	Denotes prior surgical history relevant to decision to use biologic graft material.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49560`	Repair initial incisional or ventral hernia; reducible	Primary operative technique often performed with adjunct biologic matrix placement for reinforcement.
`49565`	Repair initial incisional or ventral hernia; incarcerated or strangulated	Complex hernia repair where biologic matrix may be used when contamination or tissue quality is poor.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk	Reconstructive procedure that may be performed in conjunction with biologic matrix placement to provide soft-tissue coverage.
`15330`	Split-thickness skin graft, trunk, arms, legs; greater than 100 sq cm	Surface coverage procedure sometimes performed after debridement and placement of biologic matrix in complex wounds.
`49568`	Repair recurrent incisional or ventral hernia	Recurrent hernia repairs frequently require biologic matrix augmentation due to deficient native tissue.

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