Summary & Overview
HCPCS Q4304: Grafix Plus, Biologic Graft per Square Centimeter
HCPCS Level II code Q4304 denotes Grafix Plus, billed per square centimeter as an add-on product used to support tissue repair and advanced wound healing. As an add-on HCPCS Level II code, Q4304 is reported in addition to a primary procedure that addresses the wound or surgical site. Nationally, biologic graft materials like Grafix Plus are important for managing complex wounds, diabetic ulcers, and surgical defects when clinicians select advanced matrix or graft products to promote healing and reduce complications.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context and billing application for this product, typical sites of service where the product is used, and what to expect when reporting an add-on HCPCS Level II graft product. The content outlines the clinical purpose of the product and identifies where more detailed billing guidance or payer-specific coverage policies should be sought.
This publication provides practical reference material for billing and revenue cycle teams, clinicians involved in wound care, and policy analysts seeking clarity on how a per-square-centimeter graft product like Grafix Plus is categorized and used in medical coding and claims. Data not available in the input for benchmarks, specific payer policies, associated taxonomies, and ICD-10 diagnoses.
Billing Code Overview
HCPCS Level II code Q4304 represents Grafix Plus graft material billed per square centimeter as an add-on product that is listed separately in addition to a primary procedure. The service type derived from the description is biologic skin graft/advanced wound matrix application used to support tissue repair and wound healing. The typical site of service is outpatient clinic or facility settings where surgical or advanced wound care procedures are performed, including hospital outpatient departments, ambulatory surgical centers, and specialized wound care clinics.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a chronic, non-healing diabetic foot ulcer presents to an outpatient wound care clinic. Prior conservative measures including local wound care, debridement, offloading, and topical antimicrobials have failed to achieve satisfactory granulation. The wound care team determines that application of a placental-derived, dehydrated human tissue graft is indicated to promote healing. Grafix plus is supplied and billed per square centimeter as an add-on product. During the visit, the clinician performs wound assessment, sharp debridement of devitalized tissue, measurement of wound dimensions, irrigation, and applies the Grafix plus graft to the wound bed. The graft is secured with a nonadherent dressing and secondary dressing; patient receives wound care instructions and a follow-up appointment is scheduled for graft assessment and dressing change. Typical sites of service include outpatient wound care centers, hospital outpatient departments, ambulatory surgery centers when used with a primary procedure, and clinic-based wound care rooms. The service is billed as Q4304 in addition to the primary procedure code for debridement or other wound procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no special circumstances apply and product is billed normally. |