Summary & Overview
HCPCS Q4264: Cocoon Membrane, Per Square Centimeter
HCPCS Level II code Q4264 denotes the supply of a cocoon membrane billed per square centimeter as an add-on item to a primary surgical procedure. The code captures a discrete implant or barrier membrane used intraoperatively and is relevant to surgical specialties that employ biologic or synthetic membranes for wound coverage, tissue regeneration, or device encapsulation. Nationally, accurate use of this HCPCS code affects procedural documentation, supply tracking, and aggregate reporting for device utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for membrane use, typical sites of service such as hospital operating rooms and ambulatory surgery centers, and which payers commonly adjudicate add-on supply codes. The publication outlines benchmarking considerations, coding and billing practices associated with add-on supply reporting, and common modifiers used alongside add-on supply codes.
This summary provides a concise reference for coding professionals, revenue cycle staff, and surgical service managers seeking to understand how HCPCS Level II code Q4264 is used, where it applies clinically, and which major payers are typically involved in coverage and payment decisions. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code Q4264 describes a cocoon membrane billed per square centimeter as an add-on, list separately in addition to primary procedure. This code is used to report the supply of a cocoon membrane when it is applied as part of a surgical procedure.
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Service type: Surgical supply for use during operative procedures
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a full-thickness or complex soft-tissue wound (e.g., traumatic degloving injury, chronic nonhealing ulcer after oncologic resection, or large surgical soft-tissue defect) requiring placement of a bioresorbable barrier membrane to manage scar formation and support tissue regeneration. The procedure is provided as an adjunct to a primary reconstruction or wound-management procedure performed in the operating room or ambulatory surgical center. The clinical workflow: preoperative evaluation confirms wound characteristics and indication for membrane augmentation; the primary procedure (for example, excision, flap coverage, or grafting) is performed; the cocoon membrane is trimmed to required size and placed over or between tissue layers; the membrane is secured per surgeon preference; standard wound closure or dressing is completed; postoperative instructions address wound care and follow-up for assessment of integration and healing. Typical site of service is hospital inpatient or outpatient surgery center; procedure is coded as an add-on supply charge reported per square centimeter using Q4264 in addition to the primary procedure CPT code(s).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no additional modifier applies |