Summary & Overview
HCPCS Q4239: Amnio-maxx Amniotic Membrane Allograft, per cm
HCPCS Level II code Q4239 denotes the per-square-centimeter billing for Amnio-maxx or Amnio-maxx lite, an amniotic membrane allograft used as an add-on product to surgical or wound care procedures. This code matters nationally because amniotic membrane biologics are increasingly used across surgical specialties and wound management, creating implications for billing consistency, payer coverage policies, and provider documentation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the code’s clinical context and expected sites of service, along with the typical coverage landscape and billing considerations tied to add-on biologic graft products. The publication outlines common modifiers associated with procedure add-ons and lists the practical elements providers submit with claims.
The report summarizes available benchmarks where present, highlights recent policy clarifications affecting biologic graft reimbursement, and explains documentation elements that commonly affect medical necessity determinations. Data not available in the input is noted where applicable. The content aims to inform coding staff, billing managers, and policy analysts about the operational and payer-facing aspects of using HCPCS Level II code Q4239 in clinical practice.
Billing Code Overview
HCPCS Level II code Q4239 represents billing for Amnio-maxx or Amnio-maxx lite, billed per square centimeter as an add-on, list separately in addition to the primary procedure. The product is an amniotic membrane allograft used in tissue repair and wound or surgical site augmentation.
Service Type: Allograft biologic product / tissue graft
Typical Site of Service: Surgical or procedural settings where biologic grafts are applied, including operating rooms and specialized wound care clinics.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric surgical patient with a chronic or acute wound (e.g., diabetic foot ulcer, venous stasis ulcer, surgical wound dehiscence, or traumatic soft tissue loss) requiring application of an amniotic membrane product such as Amnio-maxx or Amnio-maxx Lite as an adjunctive biologic dressing. The patient presents to an outpatient wound clinic, ambulatory surgery center, or hospital outpatient department for debridement and wound bed preparation by a wound care specialist, plastic surgeon, podiatrist, or general surgeon. After thorough assessment and cleansing of the wound, the provider measures the defect and trims the amniotic product to size; Q4239 is billed per square centimeter as an add-on supply in addition to the primary procedure for application of the graft/dressing. Local anesthesia or conscious sedation may be provided depending on wound pain and patient tolerance. Typical workflow: wound assessment and debridement, hemostasis, sizing and application of the amniotic membrane secured with sutures, adhesives, or dressings, and post-application dressing and patient instructions. Follow-up visits occur to monitor integration, infection surveillance, and further wound care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |