Q4216 Artacent Cord HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Q4216: Artacent Cord Biologic Implant, Per Square Centimeter

HCPCS Level II code Q4216 denotes Artacent cord billed per square centimeter as an add-on product reported in addition to a primary surgical procedure. As a supply-specific HCPCS code, it standardizes reporting for a biologic implant used in operative wound or tissue repair and enables consistent billing across facility-based settings. Nationally, codes like Q4216 matter because they affect facility supply tracking, reimbursement of implantable biologics, and transparency around per-unit use of advanced graft materials.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of implantable biologic cord products, guidance on typical sites of service where the code is reported, and what to expect in payer coverage patterns and billing practice. When payer-specific data are available, the publication covers common modifiers used with add-on HCPCS supplies, typical billing scenarios, and comparison points for facility billing.

The piece provides benchmarks and policy context relevant to hospitals and ambulatory surgical centers that use implantable biologic materials. It highlights where to look for payer policy language, how add-on supply codes integrate with primary procedure reporting, and next steps for coding and claims teams to ensure accurate capture of per-square-centimeter charges. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4216HCPCS Level IIbiologic implantadd-on supplyimplantable graftfacility billingsurgical supplieshospital outpatient

Billing Code Overview

HCPCS Level II code Q4216 describes Artacent cord, per square centimeter (add-on, list separately in addition to primary procedure). This code represents a biologic implant product billed as an add-on supply item measured and reported per square centimeter.

Service type: Biologic implant/product application
Typical site of service: Hospital outpatient setting, ambulatory surgical center, or other procedure-based facilities where the primary surgical procedure is performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult undergoing a reconstructive or wound coverage procedure where a biologic extracellular matrix product, billed as Q4216 (Artacent cord, per square centimeter, add-on), is used as an adjunct to a primary surgical procedure. Common scenarios include complex soft-tissue defects after tumor resection, chronic non-healing wounds (such as diabetic foot ulcers) requiring surgical debridement with placement of a biologic scaffold, or reconstructive procedures after traumatic loss of tissue where the product is applied to augment tissue regeneration.

Workflow: The patient presents to an outpatient surgical center or hospital operating room for the primary procedure (for example, debridement, excision, or flap/skin graft). After the primary procedure code is documented and reported, the operating surgeon orders application of the biologic product. The surgical team documents product type, total square centimeters used, lot numbers, and the clinical indication in the operative note. Billing staff report the primary procedure CPT code(s) and append Q4216 as an add-on line item per square centimeter, with appropriate modifiers as indicated by clinical circumstances (for example, AS for ambulatory surgical center or 62 for two surgeons). Typical sites of service are hospital inpatient, hospital outpatient, ambulatory surgical center, or specialized wound care centers.

Coding Specifications

Modifier	Description	When to Use

HCPCS Q9993: Triamcinolone Acetonide Extended-Release Injection, 1 mg

HCPCS-Q4359-CHORIPLY-PER-SQUARE-CENTIMETER-ADD-ON-GRAFT

HCPCS Q4359: Choriply, Per Square Centimeter (Add-On)

HCPCS-Q5129-BEVACIZUMAB-ADCD-BIOSIMILAR-10MG-INJECTION

HCPCS Level II Q5129: Bevacizumab-adcd (Vegzelma) Injection, 10 mg

HCPCS-Q0488-POWER-PACK-BASE-VENTRICULAR-ASSIST-DEVICE-REPLACEMENT

HCPCS Q0488: Power Pack Base for Electric Ventricular Assist Device, Replacement Only

HCPCS-Q4010-SHORT-ARM-FIBERGLASS-CAST-ADULT

HCPCS Q4010: Cast Supplies, Short Arm Fiberglass

HCPCS-Q4433-361-HCT-P-SKIN-SUBSTITUTE-PRODUCT-ADJUNCT

HCPCS Q4433: 361 HCT/P Skin Substitute Product, Adjunct

HCPCS-Q4242-AMNIOCYTE-PLUS-0-5-CC-BIOLOGIC-PRODUCT

HCPCS Q4242: Amniocyte plus, per 0.5 cc

HCPCS-Q3028-INTERFERON-BETA-1A-SUBCUTANEOUS-INJECTION-1MCG

HCPCS Q3028: Injection, interferon beta-1a, 1 mcg subcutaneous

HCPCS-Q5148-FILGRASTIM-NYPOZI-BIOSIMILAR-INJECTION-1MCG

HCPCS Q5148: Filgrastim‑txid (Nypozi) biosimilar injection, 1 microgram

HCPCS-Q4184-CELLESTA-DUO-PER-SQUARE-CENTIMETER-ADD-ON

HCPCS Q4184: Cellesta Duo per Square Centimeter, Add-On

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Taxonomy Code	Specialty	Notes
207L00000X	General Surgery	General surgeons perform debridement, tumor excision, and tissue reconstruction where biologic grafts are used.
208000000X	Plastic Surgery	Plastic and reconstructive surgeons frequently use biologic scaffolds for wound coverage and soft-tissue reconstruction.
207P00000X	Podiatry	Podiatrists apply biologic products for diabetic foot ulcers and other complex lower-extremity wounds.
207RG0400X	Vascular Surgery	Vascular surgeons manage ischemic wounds and limb salvage procedures that may use biologic matrices.
163WL0100X	Wound Care Medicine	Wound care specialists in outpatient centers apply biologic products as adjuncts to surgical debridement and grafting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L97.425`	Non-pressure chronic ulcer of left ankle with unspecified severity	Common in lower-extremity wounds where biologic scaffolds are used after debridement.
`L97.424`	Non-pressure chronic ulcer of right ankle with unspecified severity	Used for coding chronic ankle ulcers treated with advanced wound products.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers frequently require debridement and adjunctive biologic materials.
`I70.233`	Atherosclerosis of native arteries of right leg with ulceration	Ischemic ulcers often need surgical intervention and biologic support for healing.
`C49.9`	Malignant neoplasm of connective and soft tissue, unspecified	After oncologic resection, biologic matrices may be used in reconstruction of soft-tissue defects.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11043`	Debridement, muscle and/or fascia (includes epidermis, dermis, subcutaneous tissue when performed); first 20 sq cm or less	Often performed prior to placement of a biologic scaffold to remove necrotic tissue and prepare the wound bed for `Q4216` application.
`15271`	Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less	Skin substitute procedures may be performed in combination with biologic matrix placement; coder must report primary graft code with `Q4216` as an add-on per square centimeter as appropriate.
`15100`	Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less	Autografting is commonly performed after wound bed preparation; `Q4216` may be used adjunctively to support graft take.
`15734`	Muscle, myocutaneous or fasciocutaneous free flap with microvascular anastomosis	Complex reconstructions that include flap coverage may also incorporate biologic scaffold products as adjuncts; report `Q4216` in addition to the primary reconstructive CPT.
`97602`	Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., sharps, enzymatic, mechanical), first 20 sq cm or less	In outpatient wound care settings, selective debridement precedes application of biologic products billed with `Q4216`.

`00`	No modifier; default billing indicator	Use when no special reporting modifier applies.
`22`	Increased procedural services	Use when the primary procedure required substantially greater work than usual.
`23`	Unusual anesthesia due to patient condition	Use when general anesthesia is required for an otherwise local/regional procedure.
`52`	Reduced services	Use when the biologic product was partially used or the procedure was intentionally reduced.
`53`	Discontinued procedure	Use when the procedure using the product was started but discontinued.
`54`	Surgical care only	Use when another provider manages postoperative care; the product application occurred during the surgical episode.
`55`	Postoperative management only	Use when reporting postoperative care separate from the operative application of the product.
`56`	Preoperative management only	Use when only preoperative management was provided by the reporting clinician.
`62`	Two surgeons	Use when two surgeons from different specialties each perform distinct portions, and the product application is part of the operative services.
`AS`	Ambulatory Surgical Center facility billing	Use when billing facility charges for services provided in an ambulatory surgical center.
`CO`	Cast or orthosis	Use when an orthotic device is integral to the procedure billing context (rare for this product); select only if applicable per payer rules.
`CQ`	Service furnished under a primary care exception	Use when services meet payer-specific primary care exception criteria.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when the anesthesiologist medically directs concurrent procedures associated with the surgical case.

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