Summary & Overview
HCPCS Q4165: Keramatrix or Kerasorb, per Square Centimeter
HCPCS Level II code Q4165 covers Keramatrix or Kerasorb billed per square centimeter as an add-on code used in the reporting of topical graft substitutes or advanced wound-care products applied in addition to a primary procedure. This code matters nationally because it captures area-based billing for advanced biologic or scaffold wound treatments that can materially affect episode costs and outpatient revenue for wound centers and surgical services. Major payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of Keramatrix/Kerasorb, typical sites of service where the product is applied, and what buy-side payers commonly consider when adjudicating add-on wound-care supply codes. The publication also summarizes available benchmarks and coverage trends, clarifies coding placement as an add-on supply billed per square centimeter, and outlines where to look for policy updates from national payers. Data not available in the input for payer-specific rates, claim frequency, or associated ICD-10 mappings is noted where applicable.
Billing Code Overview
HCPCS Level II code Q4165 represents Keramatrix or Kerasorb billed per square centimeter as an add-on, list separately in addition to primary procedure. The code is used to report application of a specialized wound-care product measured and billed by area.
Service Type: Wound care supply application / topical graft substitute
Typical Site of Service: Outpatient wound care clinics, hospital outpatient departments, ambulatory surgery centers, and other outpatient settings where topical graft substitutes are applied
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic or non-healing cutaneous wound (for example, a diabetic foot ulcer, venous stasis ulcer, pressure ulcer, or surgical wound dehiscence) treated in an outpatient wound care clinic or hospital wound care service. The wound care clinician (wound care nurse, podiatrist, dermatologic surgeon, or plastic surgeon) performs debridement and wound bed preparation, measures wound area in square centimeters, and applies a bioabsorbable keratin-based wound matrix product (marketed as Keramatrix or Kerasorb) as an adjunct to the primary procedure. The product is supplied and billed as an add-on per square centimeter using Q4165 in addition to the primary procedure code (such as debridement or complex wound repair). Typical workflow: wound assessment and documentation of diagnosis and size, wound cleansing and debridement as indicated, preparation of wound bed, application of the keratin-based matrix sized to the wound area, dressing and patient education, and follow-up wound checks.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the primary procedure paired with Q4165 (document rationale). |