Summary & Overview
HCPCS Q4289: Revoshield + Amniotic Barrier, Per Square Centimeter
HCPCS Level II code Q4289 designates Revoshield combined with an amniotic barrier, billed per square centimeter as an add-on supply in addition to a primary procedure. This code captures use of a biologic adjunct applied during surgical or wound care procedures to support tissue repair and barrier function. Nationally, Q4289 matters for facilities and practitioners that use advanced biologic dressings and implants because it standardizes reporting and enables separate tracking of the product component of procedural episodes.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the product, expected sites of service, common billing modifiers and workflow considerations, and how the code functions as an add-on supply line to primary procedural billing. The publication summarizes available benchmarks where provided and notes areas where data is not available.
This briefing helps billing managers, compliance officers, and clinician leaders understand when and how to report HCPCS Level II code Q4289, the clinical scenarios in which the product is used, and the payer landscape relevant to coverage and claims processing at a national level.
Billing Code Overview
HCPCS Level II code Q4289 describes Revoshield plus an amniotic barrier, billed per square centimeter as an add-on supply item to be listed separately in addition to a primary procedure. The service involves placement of a combined biologic product that includes Revoshield with an amniotic membrane barrier, intended to support tissue repair and wound healing where an adjunctive biologic barrier is indicated.
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Service type: Biologic implant / adjunctive amniotic barrier product
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Typical site of service: Outpatient surgical settings and procedural clinics where surgical wound management or tissue repair procedures are performed
Clinical & Coding Specifications
Clinical Context
A patient with a chronic, non-healing surgical wound or soft-tissue defect presents for advanced biologic adjunctive therapy. The wound is debrided in the operating room or procedure suite, hemostasis is achieved, and the surgical field is prepared. The clinician applies an amniotic barrier product combined with a Revoshield preparation to the wound bed to provide a biologic scaffold and antimicrobial barrier. The billing is reported per square centimeter with Q4289 as an add-on code reported in addition to the primary procedure for wound repair, soft-tissue reconstruction, or surgical debridement. Typical sites of service include hospital outpatient departments, ambulatory surgery centers, and office-based procedure suites where minor to moderate surgical wound management and biologic graft placement occur. Common clinical workflow steps: wound assessment and measurement, sharp or surgical debridement, irrigation, placement and fixation of the amniotic barrier/Revoshield product sized to the measured area, and documentation of square centimeters used and the primary procedure code. Indications commonly include complex or chronic wounds, surgical-site defects after excision, or augmentation of soft-tissue healing when biologic barrier and antimicrobial adjuncts are clinically indicated. Documentation must support a primary procedure code for the surgical service and clear measurement of product area to support Q4289 units billed per square centimeter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|