Summary & Overview
HCPCS Q4248: Dermacyte Amniotic Membrane Allograft, Per sq cm
HCPCS Level II code Q4248 identifies Dermacyte amniotic membrane allograft billed per square centimeter as an add-on supply when used in conjunction with a primary procedure. As an adjunctive biologic graft, this product is relevant to clinicians and billing teams involved in complex wound care and soft-tissue repair across outpatient and ambulatory surgical settings. Nationally, standardized reporting of product-based add-on codes like Q4248 affects reimbursement clarity and utilization tracking for advanced wound therapies.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common places of service, and typical billing considerations tied to this add-on graft product. The publication summarizes payer coverage patterns and benchmarks where available, highlights relevant billing practice implications for service lines involved in wound care, and flags areas where policy updates or local payer edits may affect claim processing. Data not available in the input is noted where applicable. This summary is intended for national audiences seeking a clear, practice-oriented briefing on use and billing of amniotic membrane allografts represented by HCPCS Level II code Q4248.
Billing Code Overview
HCPCS Level II code Q4248 describes Dermacyte amniotic membrane allograft, billed per square centimeter (add-on, list separately in addition to primary procedure). This code represents an amniotic membrane allograft product used as an adjunctive biologic graft in wound care and soft-tissue repair.
Service type: Allograft biologic product (amniotic membrane), supplied per square centimeter as an add-on item
Typical site of service: Outpatient wound care centers, hospital outpatient departments, ambulatory surgical centers, and physician offices where biologic grafts are applied as adjuncts to primary procedures
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with a chronic, non-healing lower extremity ulcer (full-thickness wound with inadequate healing after standard care) presents to an outpatient wound care clinic. After evaluation by a wound care specialist or podiatrist, conservative measures (debridement, offloading, infection control, dressings) have not produced expected progress. The clinician determines that an adjunctive biologic dressing is indicated and applies a Dermacyte amniotic membrane allograft as an adjunct to the primary wound procedure. The allograft is measured and billed per square centimeter. Typical workflow: initial wound assessment and photography, sharp or mechanical debridement of necrotic tissue, hemostasis, application of the amniotic membrane allograft sized to the wound bed, securement with appropriate dressings or fixation, and scheduling follow-up visits for graft checks and dressing changes. Typical sites of service include hospital outpatient departments, ambulatory surgical centers, and specialty wound care clinics. The typical patient is older, often with comorbidities such as diabetes mellitus or peripheral vascular disease, and has a chronic wound failing standard therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstance applies; bill the add-on per sq cm with primary procedure. |