Summary & Overview

HCPCS Q4347: Rampart dl Matrix, per Square Centimeter

HCPCS Level II code Q4347 designates the Rampart dl matrix, billed per square centimeter as an add-on supply used in conjunction with primary surgical or wound-care procedures. This code is relevant nationally for facilities and clinicians that use biologic or synthetic matrix products to support tissue repair and wound healing. Proper coding of add-on product units affects claim adjudication, supply cost capture, and clinical documentation.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the product, typical sites of service where the matrix is used, and the role of the code as an add-on supply. The publication also provides benchmarking context, payer coverage considerations, and coding guidance relevant to billing teams and revenue cycle managers.

The analysis covers national reimbursement and utilization patterns, common modifiers used with add-on supplies, and documentation elements that payers typically review during claim processing. Data not available in the input is noted where applicable; the primary focus remains on clarifying the code's purpose, service setting, and implications for billing and clinical teams that manage wound-care and surgical supply billing.

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Billing Code Overview

HCPCS Level II code Q4347 describes a Rampart dl matrix, billed per square centimeter. This is an add-on, list separately in addition to primary procedure supply/product used to support wound care or tissue repair procedures.

Service Type: Implantable biomaterial / wound matrix product

Typical Site of Service: Outpatient procedure suites, hospital ambulatory surgical centers, and wound care clinics

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a full-thickness or complex partial-thickness wound of the skin after trauma, surgical excision of necrotic tissue, or chronic ulceration (for example, diabetic foot ulcer or pressure ulcer) requiring advanced wound coverage. The clinician prepares the wound bed with debridement and hemostasis, measures the defect in square centimeters, and applies an extracellular matrix product — in this case the Rampart dl matrix — as an adjunctive biologic scaffold to support tissue regeneration. The service is billed as an add-on, reported per square centimeter with Q4347 in addition to a primary procedure or application code that describes the debridement or wound repair.

Typical workflow:

The patient is evaluated in the outpatient wound clinic, emergency department, or operating room for a complex wound.
The primary procedure (for example, debridement, excision, or graft placement) is performed and documented with the appropriate CPT code(s).
The wound is measured and the provider documents the number of square centimeters of matrix applied.
The Rampart dl matrix is applied and secured according to manufacturer instructions; documentation includes product name, lot number, quantity (cm2), and clinical rationale.
Billing is submitted with the primary procedure CPT code(s) and the add-on HCPCS Level II code Q4347 with the appropriate modifier(s) to reflect circumstances of service or payer requirements.

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified modifier (some payers treat as no modifier)	Rarely used; generally avoid unless payer specifically requires a placeholder modifier.
`22`	Increased procedural services	Use when work or complexity for application of the matrix is substantially greater than typical and is well documented.
`23`	Unusual anesthesia	Use when the usual local anesthesia cannot be used and documentation supports medically necessary unusual anesthesia for the procedure.
`52`	Reduced services	Use when the full intended matrix application could not be completed and documentation supports partial delivery.
`53`	Discontinued procedure	Use when the matrix application was started but terminated for patient-related or intra-procedural reasons.
`62`	Two surgeons	Use when two surgeons of different specialties actively participate and documentation supports shared surgical responsibility for the wound repair and matrix application.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when a subsequent related operative procedure for the same wound requires additional matrix placement during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice provider serves as an assistant at surgery during application of the matrix and payer accepts this modifier.
`CO`	Services performed by a resident without an attending physician present (Medicare-specific)	Use per payer rules when applicable to denote resident-provided services.
`CQ`	Monitored anesthesia care (MAC) service by a CRNA	Use when CRNA provides MAC for the procedure and payer guidance requires this modifier.

Taxonomy Code	Specialty	Notes
`174400000X`	General Surgery	General surgeons frequently perform debridement and complex wound repair with adjunctive matrices.
`176000000X`	Plastic Surgery	Plastic and reconstructive surgeons commonly apply biologic matrices for wound coverage and reconstruction.
`207Q00000X`	Podiatric Surgery	DPMs treat diabetic foot ulcers and other lower-extremity wounds requiring matrix application.
`363A00000X`	Wound Care Specialist	Wound care clinicians (MD/DO) or wound care centers often coordinate matrix-based therapies in outpatient settings.
`103T00000X`	Nurse Practitioner	Advanced practice providers perform and assist with wound care and product application in clinics and ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L89.303`	Pressure ulcer of sacral region, stage 3	Pressure ulcers with full-thickness skin loss often require advanced matrices for wound bed support.
`L97.409`	Non-pressure chronic ulcer of unspecified part of other part of lower leg, unspecified severity	Chronic lower-extremity ulcers (including diabetic ulcers) commonly receive extracellular matrix products to promote healing.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers frequently need debridement and biologic matrices to enhance closure and reduce infection risk.
`S81.102A`	Laceration without foreign body of right knee, initial encounter	Traumatic soft tissue defects may be treated with adjunctive matrix products after irrigation and debridement.
`L98.4`	Non-healing surgical wound	Surgical wounds that fail to heal may be managed with extracellular matrix placement as part of wound reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (includes epidermis and dermis), first 20 sq cm or less	Commonly billed when surgical debridement precedes placement of the extracellular matrix to prepare the wound bed.
`11043`	Debridement, muscle and/or fascia, first 20 sq cm or less	Used for deeper debridement of wounds prior to matrix application when muscle or fascia are involved.
`15271`	Application of biologic (eg, collagen) graft to trunk, arms, legs; first 100 sq cm or less, or peripheral vascular bypass wound of lower extremity	May be used for primary reporting of biologic graft application; `Q4347` is billed additionally per square centimeter for the specific Rampart dl matrix as an add-on product.
`15275`	Application of skin substitute graft resulting in full-thickness skin loss, trunk, arms, legs; greater than 100 sq cm	Performed when larger surface areas require coverage; the matrix product may be used adjunctively and reported with `Q4347`.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis	Performed for complex reconstruction; biologic matrix may be used adjunctively to support soft tissue coverage and reported as add-on if applicable.