Summary & Overview
HCPCS Q4185: Cellesta Flowable Amnion, 25 mg/cc (per 0.5 cc)
HCPCS Level II code Q4185 designates Cellesta flowable amnion (25 mg per cc); billed per 0.5 cc. This code captures a processed amniotic membrane product used as a biologic graft or adjunct in tissue repair, wound care, and certain surgical procedures. Nationally, use of biologic amnion products has implications for coverage policy, coding consistency, and cost management across payers.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, payer coverage landscapes, common billing modifiers, and where available, benchmarking and policy considerations relevant to biologic implant products. The publication summarizes coding guidance, billing nuances for volume-based units (per 0.5 cc), and payer-specific documentation expectations when reported.
This analysis provides clinicians, coders, and policy stakeholders with context on how Q4185 is used in practice, considerations for claims support, and factors that influence reimbursement decisions for flowable amnion products. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code Q4185 represents Cellesta flowable amnion (25 mg per cc); per 0.5 cc. The product is a flowable amniotic membrane preparation supplied by a biologics/dermatologic wound care manufacturer and intended for use in tissue repair and regenerative applications.
Service type: Biologic implant / regenerative tissue product
Typical site of service: Outpatient clinic or ambulatory surgical setting, wound care clinics, and office-based procedures
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic nonhealing soft-tissue wound (for example, a diabetic foot ulcer or venous leg ulcer) or a post-surgical soft-tissue defect where advanced biologic wound therapy is indicated. The patient is evaluated in an outpatient wound care clinic or an ambulatory surgery center. The clinician (often a wound care specialist, podiatrist, plastic surgeon, or orthopedic surgeon) performs a wound assessment, documents wound dimensions, debrides devitalized tissue as clinically indicated, and irrigates the wound. After achieving hemostasis and appropriate wound bed preparation, Q4185 (Cellesta flowable amnion, 25 mg per cc; per 0.5 cc) is prepared and applied directly into the wound bed to provide a biologic scaffold and growth factors to promote healing. The procedure may require local anesthesia or sedation depending on the site and patient tolerance. Post-application dressing and follow-up are documented, including instructions for offloading, infection surveillance, and scheduled reassessment visits. Billing is performed for the dispensed flowable amnion product using Q4185, with any applicable modifiers appended per payer rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When the work required is substantially greater than typically required for the procedure (document rationale). |