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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4197-puraply-xt-per-cm2-biologic-wound-graft
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    HCPCS Level II Q4197: Puraply XT, per square centimeter (add-on)

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4197 describes billing for Puraply XT applied as an add-on wound care product billed per square centimeter and intended to be reported in addition to a primary procedure; the service type is advanced wound care product application and the typical site of service is an outpatient clinic, hospital outpatient department, or wound care center where clinicians apply biologic or matrix dressings to treat acute or chronic wounds.

    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 patient presents to an outpatient wound care clinic with a chronic non-healing full-thickness wound following soft-tissue loss after debridement of an ulcer or traumatic wound. The clinician (often a wound care specialist, plastic surgeon, or podiatrist) performs sharp surgical debridement of necrotic tissue followed by application of an advanced biologic dressing, in this case Q4197 (Puraply XT) billed per square centimeter as an add-on to the primary procedure. The typical workflow includes wound assessment and measurement, photographic documentation, obtaining informed consent, surgical preparation and local or regional anesthesia, thorough debridement or preparation of the wound bed, sizing and trimming of the Puraply XT graft to fit the defect, securing the product with sutures, staples, or a secondary dressing, and post-application wound care instructions with scheduled follow-up for dressing changes and evaluation of graft take. Typical settings for this service are outpatient wound care clinics, ambulatory surgery centers, hospital outpatient departments, or office-based procedure suites where minor surgical procedures are performed under local anesthesia. The typical patient scenario includes comorbidities such as diabetes mellitus, peripheral vascular disease, or prior radiation to the area that contribute to impaired healing and the need for biological grafting materials. Documentation should include wound dimensions (cm²), clinical indication for grafting, primary procedure code supporting placement of the biologic material, exact quantity (square centimeters) of Q4197 applied, and any applicable modifier(s) to reflect unusual circumstances (for example, significant additional work or separate surgeon).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement; skin, subcutaneous tissue, and muscle, first 20 sq cm or lessCommonly billed prior to application of Q4197 when surgical debridement of the wound bed is required.
    15271Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less of productMay be used as the primary procedure when a biologic or skin substitute is applied; Q4197 billed as per-cm² add-on for additional product.
    15832Revision of skin graft, trunk, arms, legs; revision not otherwise specifiedUsed when graft placement requires subsequent revision; clinical follow-up after initial Q4197 application.
    29580Application of multi-layer compression system; leg (for venous stasis wounds)Common adjunct for offloading and compression therapy in venous ulcers treated with biologic grafting.
    97605Negative pressure wound therapy (NPWT) using disposable interface, first 7 daysMay be used before or after application of a biologic graft to assist wound bed preparation or promote graft take.

    Related Modifiers

    7 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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    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
    2279E0002XEmergency Care Registered Respiratory TherapistThe immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…
    146D00000XPersonal Emergency Response AttendantIndividuals that are specially trained to assist patients living at home with urgent/emergent situations. These individuals must be able to perform C…
    103TM1700XDeactivated - Psychologist Men & Masculinity
    246RH0600XHistology TechnicianTechnologists, Technicians & Other Technical Service Providers · Technician, Pathology
    207QH0002XHospice and Palliative Medicine (Family Medicine) PhysicianA family medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesse…
    261QR0404XCardiac Rehabilitation Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    171W00000XContractorFor the purposes of the Health Care Provider Taxonomy, a contractor is limited to individuals who do construction or mechanical work to modify a patie…
    2086S0102XSurgical Critical Care PhysicianA surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…

    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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