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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q4274-esano-ac-topical-agent-per-sq-cm-add-on
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    HCPCS Level II Q4274: Esano per Square Centimeter (Add-on)

    Medicare pays $133 on average nationally for this procedure.

    HCPCS Level II code Q4274 describes billing for Esano applied per square centimeter as an add-on service reported in addition to a primary procedure; the service type is a topical or localized therapeutic application and the typical site of service is outpatient clinics or ambulatory procedure settings where the primary procedure is performed.

    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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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with a dermatologic lesion or area of localized skin condition requiring topical treatment with a compounded agent measured and billed as an area-based additive. The patient presents to an outpatient dermatology clinic for evaluation of a hypertrophic scar, localized scleroderma plaque, or chronic wound with surrounding hypergranulation where localized application of a compounded topical acid solution (esano ac) is clinically indicated for debridement, modulation of scar tissue, or local chemical preparation before a procedure. The workflow includes history and focused skin exam, photographic documentation, informed consent discussing topical chemical application and potential irritation, preparation of the site, measurement of treated surface area in square centimeters, application of the agent by the clinician or supervised staff, observation for immediate reaction, and post-application wound/skin care instructions. Billing uses the add-on HCPCS Level II code Q4274 reported in addition to a primary procedure code (for example wound care, scar revision, or debridement) with the quantity reflecting the number of square centimeters treated. Typical site of service is an outpatient clinic or ambulatory surgical center. Common patient modifiers may capture medical necessity, bilateral or multiple sites, or unusual procedural circumstances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11042Debridement, subcutaneous tissue (e.g., wound debridement)Often performed before or in conjunction with topical chemical applications to prepare wound bed; primary procedure to which Q4274 would be appended.
    12001Simple repair of superficial wounds (e.g., 2.5 cm or less)Minor skin procedures where localized topical agents may be applied post-repair for scar modulation; Q4274 billed as an add-on for area-based agent.
    13101Repair of traumatic laceration, 2.5 cm to 7.5 cm, scalp, arms, legs; layered closureScar management procedures where topical chemical agents are applied intra- or post-operatively and area is measured in cm2 for Q4274 billing.
    15271Application of a skin substitute graft to trunk, arms, legs, first 100 sq cmFor complex wound coverage workflows where additional localized topical agents may be used; Q4274 could be reported for adjunctive area-based therapy.
    97597Debridement (e.g., selective debridement)Concurrent wound care service where topical chemical agents are used as adjunctive therapy; supports medical necessity for Q4274.

    Related Modifiers

    9 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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207N00000XDermatology PhysicianA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    208100000XPhysical Medicine & Rehabilitation PhysicianPhysical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    251300000XLocal Education Agency (LEA)The term local education agency means a public board of education or other public authority legally constituted within a State to either provide admin…
    133V00000XRegistered DietitianA Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of diet…
    224L00000XPedorthistAn individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, a…
    177F00000XLodging ProviderA public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical ser…

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    E10.621Type 1 diabetes mellitus with foot ulcer
    E11.621Type 2 diabetes mellitus with foot ulcer
    I83.011Varicose veins of right lower extremity with ulcer of thigh
    I83.012Varicose veins of right lower extremity with ulcer of calf
    L03.115Cellulitis of right lower limb
    L03.116Cellulitis of left lower limb
    L89.301Pressure ulcer of unspecified buttock, stage 1
    L89.302Pressure ulcer of unspecified buttock, stage 2
    L89.303Pressure ulcer of unspecified buttock, stage 3
    L89.321Pressure ulcer of left buttock, stage 1

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    9 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 Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01

    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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