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    v1.0.31
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4151-amnioband-guardian-per-square-centimeter
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    HCPCS Level II Q4151: Amnioband or Guardian, Per Square Centimeter

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4151 describes billing for an amnioband or amniotic guardian device billed per square centimeter as an add-on supply used during fetal membrane repair or related intrauterine procedures; the service type is a surgical supply/add-on device and the typical site of service is an operating room, labor and delivery suite, or other procedural setting where membrane repair or fetal interventions occur.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult or pediatric surgical patient requiring soft-tissue coverage or reinforcement during reconstructive or wound repair procedures. The procedure involves application of an amniotic membrane product marketed as an "Amnioband" or "Guardian" measured and billed per square centimeter using Q4151 as an add-on code in addition to the primary surgical procedure. Common scenarios include management of chronic non-healing wounds (e.g., diabetic foot ulcer), surgical reinforcement following tendon or nerve repair, exposure repair after trauma, or adjunctive coverage in ophthalmic, plastic, or general surgical reconstructions.

    Workflow: The patient presents to an outpatient surgical center, hospital operating room, or wound care clinic. After debridement or primary surgical repair (primary CPT procedure billed separately), the surgeon or wound care specialist selects appropriately sized amniotic membrane material. The product is trimmed to fit and applied to the wound bed or surgical site; securement may involve sutures, adhesives, or dressings. The service is documented with product size in square centimeters to support Q4151 as an add-on item billed in addition to the primary procedure. Typical sites of service include outpatient surgical centers, hospital outpatient departments, inpatient operating rooms, and specialized wound clinics.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue, first 20 sq cm or less; includes epidermis and dermisOften performed immediately before application of an amniotic membrane to prepare the wound bed.
    15271Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less, or up to 10% BSAFrequently billed when biological dressings or skin substitutes are used in conjunction with amniotic membrane products for larger surface areas.
    12001Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or lessMinor wound closures that may be followed by adjunctive amniotic membrane placement for enhanced healing.
    13102Repair, complex, trunk; 1.1 cm to 2.5 cmComplex closures or reconstructive procedures after which amniotic membrane may be applied as an adjunct.
    97607Negative pressure wound therapy (NPWT), application of dressing with interface, each 72 hoursUsed before or after placement of amniotic membrane as part of advanced wound management protocols.
    20550Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fasciitis")In certain tendon repair or regenerative procedures, amniotic membranes may be placed adjunctively following injectable or surgical interventions.

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    207P00000X
    207Q00000X
    213E00000X
    363A00000X
    2083A0100X
    207UN0903X
    225A00000X

    Related ICD-10-CM Codes

    11 rows

    ICD-10-CM CodeDescription
    O13.9Gestational [pregnancy-induced] hypertension without significant proteinuria, unspecified trimester
    O36.0110Maternal care for anti-D [Rh] antibodies, first trimester, not applicable or unspecified
    O36.0120Maternal care for anti-D [Rh] antibodies, second trimester, not applicable or unspecified
    O36.0910Maternal care for other rhesus isoimmunization, first trimester, not applicable or unspecified
    O36.0920Maternal care for other rhesus isoimmunization, second trimester, not applicable or unspecified
    O41.03X0Oligohydramnios, third trimester, not applicable or unspecified
    O41.03X1Oligohydramnios, third trimester, fetus 1
    O70.0First degree perineal laceration during delivery
    O70.1Second degree perineal laceration during delivery
    P02.1Newborn affected by other forms of placental separation and hemorrhage

    Showing 1–10 of 11

    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
    Pathogen Panel TestingOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar 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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