HCPCS Q4219: Surgigraft-Dual Graft Material, Per Square Centimeter - OpenPayer

Summary & Overview

HCPCS Q4219: Surgigraft-Dual Graft Material, Per Square Centimeter

HCPCS Level II code Q4219 denotes a surgigraft-dual product billed per square centimeter as an add-on item in addition to a primary surgical procedure. The code identifies reimbursable graft material used in surgical repair and reconstruction and matters nationally because add-on graft products can materially affect procedure costs, clinical choices of graft materials, and hospital and ambulatory surgical center billing practices. Payers and providers rely on accurate coding to ensure correct claim adjudication and to track utilization of advanced graft products.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical and billing context, typical sites of service, common modifiers and administrative considerations, and where to find related coding resources. The publication outlines benchmarks and coverage considerations relevant to national payer policies, highlights typical billing patterns for add-on graft products, and summarizes implications for facility and professional billing workflows. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4219HCPCS Level IIsurgigraftgraft materialadd-on codesurgical billingoperating roomoutpatient surgeryprocedure supplies

Billing Code Overview

HCPCS Level II code Q4219 describes a surgigraft-dual product, billed per square centimeter as an add-on item to be listed separately in addition to the primary procedure. The service type implied by this description is graft material application for surgical repair or reconstruction, and the typical site of service is operating room or outpatient surgical facility where surgical grafting procedures are performed.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult undergoing reconstructive surgery for full‑thickness soft tissue defects where placement of a dual-layer surgical graft (Surgigraft‑dual) is indicated to support wound closure and tissue regeneration. Common scenarios include large traumatic degloving injuries of an extremity, surgical excision of malignancy with resultant soft tissue deficit, or revision reconstructive procedures that require an adjunctive biologic/engineered graft to augment coverage.

The clinical workflow begins with preoperative assessment by the surgical team (often plastic surgery, general surgery, or orthopedic surgery). Appropriate imaging and wound bed preparation occur preoperatively. During the operative procedure, the primary operative code (e.g., flap, skin graft, or debridement) is reported; Q4219 is billed as an add‑on per square centimeter to reflect the additional quantity of Surgigraft‑dual applied. Documentation must specify the graft type, total square centimeters implanted, anatomic site, indication, and that the graft is adjunctive to the primary procedure. Postoperative care includes dressing changes, monitoring for graft take, and wound care visits. Typical sites of service are hospital operating room, ambulatory surgical center, or inpatient surgical suite depending on case complexity and patient status.

Coding Specifications

Modifier	Description	When to Use
`00`

HCPCS Q4130: Strattice™ Per Square Centimeter, Surgical Mesh

HCPCS-Q0520-PHARMACY-PREP-INJECTABLE-60-DAY-SUPPLY

HCPCS Level II Q0520: Pharmacy Fee for Injectable HIV PrEP, 60-Day Supply

HCPCS-Q4250-AMNIOAMP-PER-SQUARE-CENTIMETER

HCPCS Level II Q4250: Amnioamp-mp, Per Square Centimeter

HCPCS-Q4038-SHORT-LEG-FIBERGLASS-CAST-SUPPLIES-ADULT

HCPCS Q4038: Cast Supplies, Short Leg Fiberglass, Adult (11+)

HCPCS-Q4248-DERMACYTE-AMNIOTIC-MEMBRANE-ALLOGRAFT-PER-CM

HCPCS Q4248: Dermacyte Amniotic Membrane Allograft, Per sq cm

HCPCS-Q4411-AMNIOMATRIX-AMNIOTIC-MATRIX-PER-CM2

HCPCS Level II Q4411: Amniomatrix per Square Centimeter (Add-on)

HCPCS-Q4028-PEDIATRIC-HIP-SPICA-FIBERGLASS-CAST-SUPPLIES

HCPCS Level II Q4028: Pediatric Hip Spica Fiberglass Cast Supplies

HCPCS-Q0166-GRANISETRON-ORAL-ANTI-EMETIC-CHEMOTHERAPY-SUBSTITUTE

HCPCS Q0166: Granisetron 1 mg Oral Anti‑Emetic for Chemotherapy

HCPCS-Q5153-AFLIBERCEPT-YSZY-INTRAVITREAL-INJECTION-1MG

HCPCS Level II Q5153: Injection, aflibercept-yszy (Opuviz), 1 mg

HCPCS-Q4334-AMNIOPLAST-PER-SQUARE-CENTIMETER-ADD-ON

HCPCS Q4334: Amnioplast, per Square Centimeter (Add-on)

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Taxonomy Code	Specialty	Notes
`208100000X`	Plastic Surgery	Most common specialty performing complex soft‑tissue reconstruction and graft placement.
`207T00000X`	Orthopaedic Surgery	Frequently involved for extremity trauma reconstruction requiring graft augmentation.
`207Q00000X`	General Surgery	Performs oncologic resections and reconstructions where adjunctive grafts are applied.
`183500000X`	Podiatry	Applicable for foot/ankle soft tissue reconstruction when grafting is required.
`363L00000X`	Burn Surgery (Surgical)	Manages large wound and burn reconstruction where dual‑layer graft materials are used.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T79.2XXA`	Traumatic compartment syndrome of an extremity, initial encounter	Severe extremity trauma may require grafting after debridement and reconstruction.
`S81.811A`	Laceration without foreign body of right knee, initial encounter	Soft‑tissue defects from lacerations often require adjunctive graft materials.
`C44.31`	Squamous cell carcinoma of skin of right lower limb, including hip	Surgical excision of cutaneous malignancy can produce defects requiring graft augmentation.
`L89.309`	Pressure ulcer of unspecified part of unspecified lower back, stage 3	Chronic ulcers with full‑thickness tissue loss may be managed with grafts and biologic adjuncts.
`T79.8XXA`	Other specified injuries of unspecified body region, initial encounter	Complex injuries with tissue loss that need reconstructive grafting.
`S81.809A`	Open wound of unspecified knee, initial encounter	Open wounds after trauma may be reconstructed using graft products.
`S71.011A`	Laceration with foreign body of right thigh, initial encounter	Contaminated wounds requiring debridement and subsequent grafting.
`L98.49`	Other disorders of skin and subcutaneous tissue, not elsewhere classified	Includes nonhealing wounds and soft‑tissue defects where adjunctive grafts are considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`15271`	Application of a split‑thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1 percent of body surface of infants and children	May be the primary grafting procedure to which `Q4219` is appended when additional engineered Surgigraft‑dual is used as an adjunct.
`15732`	Muscle, myocutaneous or fasciocutaneous flap; trunk	May be performed as the primary reconstructive procedure with `Q4219` reported as an adjunctive graft per square centimeter.
`11042`	Debridement, subcutaneous tissue, first 20 sq cm or less	Commonly performed prior to graft placement to prepare the wound bed; documents excision of necrotic tissue.
`13160`	Secondary closure of surgical wound, extensive or complicated (e.g., traumatic wounds)	May be used in staged reconstruction where grafting with Surgigraft‑dual supports wound closure.
`15734`	Muscle, myocutaneous or fasciocutaneous flap; lower extremity	Used when flap coverage is primary and an adjunctive graft product is applied and reported with `Q4219`.

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