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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4157-revitalon-per-sq-cm-add-on
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    HCPCS Q4157: Revitalon, per square centimeter (add-on)

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4157 represents billing for Revitalon applied per square centimeter as an add-on product billed separately in addition to a primary procedure; the service is a topical biologic/skin revitalization product typically provided in ambulatory surgical centers or outpatient dermatology/plastic surgery clinics for procedures that require adjunctive topical application measured by area. Data not available in the input.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient scenario involves an adult with a full-thickness skin defect or chronic non-healing wound undergoing surgical debridement and placement of a topical regenerative skin matrix product, billed as Q4157 (Revitalon, per square centimeter) as an add-on supply to the primary wound procedure. The service is commonly provided in an outpatient ambulatory surgery center, hospital outpatient department, or clinic procedure room under local anesthesia with or without sedation. A wound care or reconstructive clinic documents wound measurements in square centimeters to calculate units of Q4157 applied. The clinical workflow includes wound assessment, photographic documentation, debridement or preparation of wound bed, application of the Revitalon matrix to the measured wound area, dressing placement, and patient education for dressing care and follow-up. Typical patients include those with chronic diabetic foot ulcers, venous stasis ulcers, pressure injuries, or traumatic skin loss requiring biologic or synthetic regenerative matrices as adjunctive therapy to promote epithelialization and wound closure.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or lessOften performed prior to application of a regenerative matrix to prepare the wound bed
    15271Application of a biologic dressing, first 100 sq cm or less; for skin substitutes, placementCommonly reported for the primary application of a skin substitute; Q4157 billed as an add-on supply per sq cm in addition to the primary application
    15002Surgical preparation or partial-thickness skin graft, first 100 sq cm or lessMay be performed in conjunction with reconstructive procedures where matrix products supplement grafting
    97602Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet), first 20 sq cm or lessNon-surgical debridement that can precede application of the product in outpatient wound care
    13160Secondary closure of surgical wound or complex closure adjacent tissue underminingProcedures that may follow matrix application when wound edges require further approximation

    Related Modifiers

    6 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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    372500000XChore ProviderAn individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or dis…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    333600000XPharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
    2251H1200XHand Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Physical Therapist
    225XP0200XPediatric Occupational TherapistOccupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
    3418M1130XMilitary or U.S. Coast Guard Water Transport AmbulanceVehicle and staff for patient emergency or non-emergency sea/water transport

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    B35.1Tinea unguium
    B35.6Tinea cruris
    E10.621Type 1 diabetes mellitus with foot ulcer
    E11.621Type 2 diabetes mellitus with foot ulcer
    H02.831Dermatochalasis of right upper eyelid
    H02.832Dermatochalasis of right lower eyelid
    I83.013Varicose veins of right lower extremity with ulcer of ankle
    L03.115Cellulitis of right lower limb
    L03.116Cellulitis of left lower limb
    L30.0Nummular dermatitis

    Showing 1–10 of 22

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    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
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV)blue cross blue shield - louisiana2026-09-15

    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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