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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4222-progenamatrix-biologic-matrix-per-cm2
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    HCPCS Q4222: Progenamatrix per Square Centimeter (Add-on)

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4222 describes billing for Progenamatrix applied per square centimeter as an add-on product used in wound care and skin graft procedures, typically supplied in conjunction with a primary surgical or wound debridement procedure; the service is a biologic skin substitute/dermal matrix supplied for use in operating room, outpatient surgical center, or advanced wound care clinic settings and billed per cm².

    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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    Table of contents

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    • Billing CodesCPT, HCPCS, DRG & more
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    Clinical & Coding Specifications

    Clinical Context

    A patient with a full-thickness or complex partial-thickness wound (for example, a chronic non-healing diabetic foot ulcer or a deep traumatic skin loss) is evaluated in an outpatient wound clinic or ambulatory surgical center. After debridement and wound bed preparation, the treating clinician elects to apply a biological skin substitute product billed as Q4222 (Progenamatrix) to augment healing. The procedure is performed by a wound care specialist, plastic surgeon, or podiatrist. The workflow includes pre-procedure evaluation and wound measurement, sharp or surgical debridement, hemostasis, placement and securement of the Progenamatrix graft over the prepared wound per square centimeter, and application of a dressing. The service is billed in addition to the primary operative or debridement procedure using Q4222 as an add-on code with documentation of product area (cm2), medical necessity, and any applicable modifiers for circumstance (for example, modifier 22 for unusual procedural services or 59-like modifiers from the provided list when applicable). Typical sites of service are outpatient wound care centers, ambulatory surgical centers, and hospital outpatient departments. Common patient presentation scenarios include chronic diabetic ulcers failing conservative therapy, large traumatic soft tissue defects requiring biologic matrix to support granulation, or post-excisional defects after removal of infected tissue where enhanced biologic scaffold is needed to promote healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue, first 20 sq cm or lessOften performed immediately before application of Q4222 to prepare the wound bed.
    11043Debridement, muscle and/or fascia, first 20 sq cm or lessUsed for deeper debridement when wound involves muscle/fascia prior to graft/matrix placement.
    15271Application of skin substitute graft to face, scalp, neck, hands, feet, or genitalia; first 100 sq cm or lessMay be used when a coded skin substitute procedure is reported in addition to product-level reporting; documents application procedure.
    15734Muscle, myocutaneous or fasciocutaneous flap with microvascular anastomosisPerformed in more complex reconstructions where biologic matrix may be used as adjunct.
    29580Application of multi-layer compression systemPost-procedure dressing/therapy commonly used after biologic matrix placement on lower-extremity wounds.

    Related Modifiers

    8 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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    2080P0207XPediatric Hematology & Oncology PhysicianA pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    207WX0108XUveitis and Ocular Inflammatory Disease (Ophthalmology) PhysicianAn ophthalmologist who specializes in the treatment of intraocular inflammation, scleritis, keratitis and infectious disorders affecting the eye and i…
    1835C0205XCritical Care PharmacistA licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists, as integral member…
    175T00000XPeer SpecialistIndividuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans A…
    207ZF0201XForensic Pathology PhysicianA forensic pathologist is expert in investigating and evaluating cases of sudden, unexpected, suspicious and violent death as well as other specific c…
    213ES0000XSports Medicine PodiatristPodiatric Medicine & Surgery Service Providers · Podiatrist

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    L73.9Follicular disorder, unspecified
    L89.101Pressure ulcer of unspecified part of back, stage 1
    L89.202Pressure ulcer of unspecified hip, stage 2
    L89.303Pressure ulcer of unspecified buttock, stage 3
    L89.509Pressure ulcer of unspecified ankle, unspecified stage
    L89.609Pressure ulcer of unspecified heel, unspecified stage
    L97.119Non-pressure chronic ulcer of right thigh with unspecified severity
    L97.329Non-pressure chronic ulcer of left ankle with unspecified severity
    L97.429Non-pressure chronic ulcer of left heel and midfoot with unspecified severity
    L97.519Non-pressure chronic ulcer of other part of right foot with unspecified severity

    Showing 1–10 of 22

    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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