Summary & Overview
HCPCS Q4305: American Amnion AC Tri-Layer Graft, Per Sq Cm
HCPCS Level II code Q4305 designates an American amnion AC tri-layer biologic graft billed per square centimeter as an add-on to a primary surgical procedure. This code captures use of a tri-layer amniotic membrane product applied during operative wound repair or reconstructive surgeries and is relevant for hospitals, ambulatory surgery centers, and surgical specialty practices that utilize biologic grafts.
Key payers in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code describes the service, typical clinical settings where the graft is used, and what to expect in payer coverage considerations. The publication outlines benchmarks and coding context for the add-on, per-square-centimeter billing unit, highlights common billing modifiers and administrative elements, and situates the code within broader clinical use of amniotic membrane products.
The content provides practical policy and billing context rather than clinical guidance, summarizing what clinicians and billing teams need to know about documenting and submitting claims that include this add-on graft product. Data not available in the input.
Billing Code Overview
HCPCS Level II code Q4305 represents an American amnion AC tri-layer graft billed per square centimeter as an add-on, list separately in addition to primary procedure. The product is a biologic graft derived from amniotic membrane intended for tissue repair and regenerative applications.
Service Type: Graft / biologic tissue application
Typical Site of Service: Operating room or procedure suite — used as an adjunct during surgical wound repair, reconstructive procedures, or other operative settings where biologic grafts are applied.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a chronic, non-healing full-thickness lower extremity wound following surgical debridement is evaluated in an outpatient wound care clinic. After standard wound bed preparation, irrigation, and control of infection, the treating wound care surgeon elects to apply an amniotic membrane allograft product (American amnion ac tri-layer) as an adjunct to promote tissue regeneration and epithelialization. The product is billed per square centimeter using Q4305 as an add-on, reported in addition to the primary wound repair or debridement procedure. Typical workflow includes wound measurement and documentation of dimensions, photographic documentation, selection of appropriate graft size, placement of the tri-layer amnion over the prepared wound bed, fixation with sutures or adhesive as clinically indicated, application of a secondary dressing, and post-procedure instructions for offloading and dressing changes. The service is commonly performed in an ambulatory surgery center, hospital outpatient department, or office-based specialty wound clinic. Documentation includes the primary procedure CPT code for debridement or repair, the Q4305 line item with the total square centimeters used, relevant wound characteristics, and any applicable modifier(s) to reflect unusual circumstances or responsible practitioner details (for example, modifier 62 for co-surgery or AS for ambulatory surgery center).
Coding Specifications
| Modifier | Description | When to Use |
|---|