Summary & Overview
HCPCS Level II Q4295: Amnio Tri-Core Amniotic Graft, Per Sq Cm
HCPCS Level II code Q4295 denotes an add-on billing code for billing amnio tri-core amniotic material, charged per square centimeter when used in addition to a primary surgical or procedural service. Nationwide, use of biologic amniotic grafts has risen across specialties such as wound care, ophthalmology, and orthopedics, making accurate add-on coding important for facility and professional claims.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for HCPCS Level II code Q4295, typical sites of service, and the administrative role of an add-on per-square-centimeter code. The publication outlines common modifier use and payer-specific coverage considerations where available. It also summarizes benchmarking and billing practice implications relevant to revenue cycle, appeals, and prior authorization workflows.
This summary is intended to give administrators, coders, and policy analysts a clear, national-level overview of the code’s purpose, when it is applicable, and what practical billing topics are addressed in the full publication.
Billing Code Overview
HCPCS Level II code Q4295 describes amnio tri-core amniotic, billed per square centimeter as an add-on, list separately in addition to primary procedure. This code represents a biologic graft material derived from the amniotic membrane used to support tissue repair and regeneration.
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Service type: Biologic graft placement / adjunctive wound or tissue repair therapy
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Typical site of service: Outpatient surgical settings or ambulatory procedure centers where the primary procedure requiring graft augmentation is performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric surgical patient with a chronic, non-healing wound or soft-tissue defect after debridement, prior surgery, or trauma who receives an amniotic membrane graft (Amnio tri-core) to promote wound healing. The clinical workflow begins with wound assessment in an outpatient wound clinic or inpatient surgical service. After determining that conservative measures have failed and the wound bed is suitable (adequate perfusion, controlled infection), the provider measures the defect in square centimeters and selects the appropriate size of Q4295 (amniotic, per square centimeter). The procedure is performed in a minor procedure room, outpatient clinic procedure suite, ambulatory surgery center, or operating room depending on wound complexity and patient comorbidities. The graft is applied after standard wound bed preparation (debridement, hemostasis, irrigation) and secured per clinic or operative technique. Post-application care includes dressing changes, wound monitoring, and documentation of graft size in square centimeters for billing the add-on Q4295 code in addition to the primary procedure code (for example, debridement or surgical closure). Typical sites of service: outpatient wound clinic, ambulatory surgery center, hospital outpatient department, or inpatient operating room. Typical patient scenario: a 67-year-old patient with a diabetic foot ulcer failing conservative therapy undergoes sharp debridement and placement of an amniotic membrane allograft Q4295 measured at 12 cm² as an adjunct to promote healing.
Coding Specifications
| Modifier | Description | When to Use |
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