Summary & Overview
HCPCS Q4158: Kerecis Omega3 Biologic Graft, Per sq cm
HCPCS Level II code Q4158 designates Kerecis omega3 billed per square centimeter as an add-on product provided in addition to a primary procedure. This code is used when the omega-3–based fish-skin graft product is applied to support tissue repair and advanced wound care, and it matters nationally as biologic grafts and advanced wound therapies are increasingly used across outpatient and facility settings.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage and billing considerations for these payers where available and highlights operational implications for providers and billing teams.
Readers will find a concise description of the clinical use and service contexts for Q4158, typical sites of service, and which payers are commonly involved. The report provides benchmarks and policy-focused content such as coverage considerations, common modifiers, and areas where readers should verify payer-specific guidance. It also outlines clinical context for use of an omega-3 fish-skin graft in wound management and notes when separate add-on billing is applicable. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code Q4158 identifies Kerecis omega3 applied per square centimeter as an add-on, billable separately in addition to the primary procedure. The code denotes a biologic graft product composed of omega-3–rich fish skin used to support tissue repair and wound healing.
Service type: Biologic graft / wound care adjunct
Typical site of service: Outpatient wound care settings, hospital outpatient departments, ambulatory surgical centers, and specialty clinics that provide advanced wound management
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a full-thickness or complex partial-thickness soft-tissue wound (for example, a chronic non-healing lower-extremity ulcer, surgical wound dehiscence, or traumatic soft-tissue defect) requiring biologic graft placement to support wound bed repair. The procedure using Q4158 (Kerecis omega3, per square centimeter) is performed as an add-on material in conjunction with a primary wound debridement and/or closure procedure. Workflow: the wound is evaluated and photographed, sharp surgical or enzymatic debridement is performed to remove devitalized tissue, hemostasis is achieved, and the wound bed is measured. The appropriate number of square centimeters of Kerecis omega3 allograft or xenograft is selected and applied to the prepared wound bed, secured per product instructions (sutures, staples, or dressings), and covered with an appropriate secondary dressing. Post-procedure wound care instructions and follow-up visits for dressing changes and wound assessment are scheduled. Typical site of service is an outpatient wound clinic, ambulatory surgical center, or inpatient operating room when performed at the time of a primary operative wound procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure | Use when a distinct E/M visit is performed on the same day as the wound application supporting medical decision-making beyond routine pre/post-op care |