Summary & Overview

HCPCS Q4190: Artacent ac, per square centimeter (add-on)

HCPCS Level II code Q4190 designates Artacent ac billed per square centimeter as an add-on, list-separately item in addition to a primary procedure. The code captures area-based use of a topical or dermal product applied during procedures that require localized coverage, making it relevant for dermatology, wound care, and minor surgical services. Nationally, proper use of this code affects coding accuracy, claim adjudication, and product-specific cost reporting.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and service settings, guidance on where this add-on is typically reported on the claim, and an outline of the types of analyses often performed (usage benchmarks, payer coverage patterns, and coding compliance considerations). The summary highlights what to expect from benchmarking and policy reviews, while noting areas where input data was not provided. Data not available in the input is called out where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4190HCPCS Level IIArtacent actopical agentadd-on codedermatologywound carearea-based billingambulatory services

Billing Code Overview

HCPCS Level II code Q4190 describes Artacent ac, billed per square centimeter as an add-on service to be listed separately in addition to the primary procedure. This code represents a topical or localized dermatologic/dermal product applied to a specified area measured in square centimeters.

Service Type: Topical/dermal product application (area-based), additive to a primary procedure

Typical Site of Service: Outpatient clinics, dermatology offices, ambulatory surgery centers, and other settings where a primary procedure requiring a topical/dermal agent is performed

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a chronic full-thickness lower extremity wound resulting from peripheral vascular disease and prior debridement presents to an outpatient wound care clinic. After surgical debridement and preparation of the wound bed, the clinician applies an acellular dermal matrix product, billed as Q4190 (Artacent ac, per square centimeter) as an add-on graft material to facilitate dermal regeneration. The typical workflow includes pre-procedure evaluation and wound measurement, informed consent, operative or bedside debridement and hemostasis, application and fixation of the product to the prepared wound, appropriate dressing placement, and post-application wound care instructions with planned follow-up visits for assessment and potential repeat applications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Use when no modifier applies and service is billed normally.
`22`	Increased procedural services	Use when the work required to apply the graft is substantially greater than typical (document increased complexity).
`52`	Reduced services	Use when a reduced application is performed relative to the full procedure (document reasons).
`53`	Discontinued procedure	Use when application was started but discontinued for patient safety or other documented reason.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure.
`78`	Return to OR for related procedure	Use when the patient returns to the operating room for a related procedure for complications.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare-covered part B services	Use when these clinicians perform or assist in parts of the service per payer rules.
`QK`	Medical direction of two, three, or four qualified personnel	Use when the physician medically directs multiple qualified health care professionals during the procedure.
`QX`	Modifier certifying presence of assistant (assistant-at-surgery)	Use when a qualified assistant-at-surgery is present and documented.

Taxonomy Code	Specialty	Notes
`163W00000X`	Wound Care Specialist	Clinicians primarily focused on complex wound management and product application.
`207P00000X`	Podiatrist	Commonly manages lower-extremity wounds and performs graft applications in the foot/ankle region.
`207L00000X`	Orthopedic Surgery	Often involved when wounds relate to musculoskeletal or post-operative issues.
`207N00000X`	Plastic Surgery	Performs dermal grafting and reconstruction in complex soft tissue defects.
`131J00000X`	Vascular Surgery	Manages ischemic wounds and coordinates revascularization with graft application.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.013`	Varicose veins of right lower extremity with ulcer of calf	Chronic venous insufficiency ulcers often require debridement and dermal substitute application.
`I70.231`	Atherosclerosis of native arteries of right leg with ulceration of calf	Ischemic ulcers from peripheral arterial disease may be treated with acellular dermal matrix after revascularization and debridement.
`L97.422`	Non-pressure chronic ulcer of left calf with partial thickness skin loss	Common chronic ulcer indication for advanced wound therapies including dermal matrices.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers frequently require biologic grafts to support healing after wound bed preparation.
`T81.4XXA`	Infection following a procedure, initial encounter	Post-procedural wound complications or infected wounds may necessitate additional grafting procedures or management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (includes local anesthesia, when performed); first 20 sq cm or less	Often performed immediately prior to `Q4190` application to prepare the wound bed.
`11043`	Debridement, muscle and/or fascia; first 20 sq cm or less	Used when deeper debridement is required before applying dermal matrix product.
`15271`	Application of a skin substitute graft to trunk, arms, legs; first 100 sq cm or less, or each graft less than 100 sq cm	Application of skin substitute grafts may be reported alongside `Q4190` when a composite of products or procedures is used.
`15732`	Placement of biologic implant for soft tissue wound closure; trunk, arms, legs, first 100 sq cm or less	May be reported when biologic implants are used for wound closure in conjunction with acellular dermal matrix.
`97597`	Debridement (e.g., high-pressure water), open wound, start of serial debridement by a wound care professional; first 20 sq cm or less	Used for serial wound care debridement performed in clinic prior to or after graft application.