Summary & Overview
HCPCS Level II Q4230: Cogenex Flowable Amnion, 0.5 cc
HCPCS Level II code Q4230 denotes Cogenex flowable amnion supplied per 0.5 cc and is used to bill for a small-volume biologic allograft product applied in wound care and tissue repair settings. Nationally, the code matters as use of amniotic-derived biologics has grown across outpatient, ambulatory surgery, and specialty clinic settings for soft-tissue and wound applications, driving payer coverage and coding attention.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for this product, common service locations where the product is administered, and the kinds of reimbursement and policy issues payers typically evaluate for similar biologic allografts.
This publication provides benchmarks for coding and billing practices, summarizes typical clinical indications and service lines, and highlights policy considerations that influence coverage decisions and claim adjudication for small-volume amniotic products. Where specific payer policy details or related billing data are not provided in the source, the report notes that such data are not available in the input and focuses on the available national-level clinical and billing context.
Billing Code Overview
HCPCS Level II code Q4230 describes Cogenex flowable amnion, per 0.5 cc. This code represents a biologic allograft product consisting of flowable amniotic membrane material intended for use in clinical applications where a small-volume, injectable or topical amnion preparation is indicated.
Service Type: Biologic allograft product (flowable amnion)
Typical Site of Service: Outpatient procedural settings, ambulatory surgery centers, physician offices, and wound care clinics where biologic grafts or topical regenerative therapies are applied
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic nonhealing wound (e.g., diabetic foot ulcer, venous leg ulcer, or surgical wound dehiscence) who has failed standard wound care including debridement, offloading, infection control, and advanced dressings. The treating clinician (commonly a wound care specialist, podiatrist, or plastic surgeon) evaluates the wound, documents wound dimensions, depth, baseline photos, vascular status, and prior therapies. After determining that biologic advanced therapy is appropriate, the clinician prepares the wound at the bedside or in a minor procedure room by removing necrotic tissue and achieving hemostasis. The provider then applies Q4230 (Cogenex flowable amnion, per 0.5 cc) to the wound bed, typically delivered as a flowable amniotic membrane product to fill irregular defects and promote healing. Post-application wound care instructions, dressing selection, and follow-up visits are documented. The product is billed per 0.5 cc unit, with documentation of quantity used, lot numbers, and indication for medical necessity recorded in the chart.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no special circumstances apply |
22 |