Summary & Overview

HCPCS Q4364: Amnio Burgeon Xplus Membrane and Hydromembrane, per cm2

HCPCS Level II code Q4364 covers the use of amniotic-derived membrane products — Amnio burgeon xplus membrane and xplus hydromembrane — billed per square centimeter as an add-on to a primary procedure. These biologic membranes are used as adjunctive materials in wound management and surgical reconstruction, providing a billing mechanism for per-area application of advanced wound care products. Nationally, codes for biologic membranes matter because they affect facility and professional billing for high-cost adjunctive products and influence access to advanced wound therapies.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and service settings, payer coverage landscape, common billing modifiers, and typical coding considerations. The publication provides benchmarks for utilization and reimbursement where available, notes recent policy or coverage updates relevant to biologic membrane products, and outlines operational implications for billing teams and revenue cycle managers. Data not available in the input is clearly identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4364HCPCS Level IIAmniotic membraneWound careBiologic graftAdd-on codeOutpatient surgeryRevenue cycle

Billing Code Overview

HCPCS Level II code Q4364 describes Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure). The code represents billing for biologic membrane products applied as part of a wound or surgical site procedure; each unit is reported per square centimeter and is billed in addition to the primary procedure.

Service Type: Advanced wound care / biologic membrane grafting

Typical Site of Service: Hospital outpatient departments, ambulatory surgical centers, wound care clinics, and other procedural settings where membranes are applied as adjuncts to surgical or wound interventions.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a chronic, nonhealing lower extremity wound or surgical soft-tissue defect referred to a wound care clinic or plastic surgery service for advanced biological dressing application. The patient often has comorbidities such as diabetes mellitus, peripheral arterial disease, or prior radiation that impair wound healing. After evaluation, the clinician debrides necrotic tissue, assesses wound dimensions, and determines need for adjunctive biologic membrane placement (amnio burgeon xplus membrane or xplus hydromembrane). The product is applied to the prepared wound bed as an adjunct to standard wound care; the billed unit is per square centimeter and is reported as an add-on code in addition to a primary debridement or reconstructive procedure. Typical workflow: wound assessment and measurement, informed consent, surgical or bedside debridement (if indicated), preparation of membrane to match wound size, application and securement of the membrane, dressing and follow-up visits for serial wound assessment.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no special circumstances apply to the add-on product billing.
`22`	Increased procedural services	Use when work or resources required to apply the membrane are substantially greater than typical (document rationale).
`23`	Unusual anesthesia — medically necessary	Use if general anesthesia is required for membrane placement and anesthesia is unusual for the primary procedure.
`52`	Reduced services	Use when the membrane application was partially performed or truncated.
`53`	Discontinued procedure	Use when procedure was started but discontinued prior to membrane application.
`54`	Surgical care only	Use when the reporting provider furnished only the surgical portion and not pre/post care.
`55`	Postoperative management only	Use when the reporting provider furnished only postoperative care after membrane placement.
`56`	Preoperative management only	Use when the reporting provider furnished only preoperative management related to the procedure.
`62`	Two surgeons	Use when two surgeons of different specialties actively participate in placement due to complexity.
`78`	Unplanned return to OR	Use when patient returns to the operating room for a related procedure on the same wound and membrane management is involved.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician assists in the operative application.
`CO`	Left-hand/Right-hand modifiers are not applicable here but retained in list	Use is generally not applicable to membrane product billing.
`CQ`	Skilled non-physician practitioner	Use when a non-physician practitioner provides services that are billable in conjunction with the procedure as allowed.
`QX`	Service furnished with assistant at surgery (assistant surgeon)	Use when assistant at surgery is present and billing requires this qualification.

Taxonomy Code	Specialty	Notes
`208000000X`	General Surgery	Commonly performs debridement and application in operative settings.
`208600000X`	Plastic Surgery	Frequently performs wound reconstruction and biologic membrane placement.
`207Q00000X`	Podiatry	Commonly treats chronic lower-extremity wounds and applies grafts/membranes.
`163W00000X`	Wound Care/Hyperbaric Medicine	Specialists in advanced wound therapies and membrane application in clinic.
`207P00000X`	Family Medicine	May perform bedside application in outpatient wound clinics.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L97.409`	Non-pressure chronic ulcer of unspecified part of right lower leg with unspecified severity	Represents a common chronic lower-extremity ulcer where amniotic membrane adjuncts are applied to promote healing.
`L97.419`	Non-pressure chronic ulcer of unspecified part of left lower leg with unspecified severity	Applicable to chronic wounds on the contralateral lower extremity treated with biologic membranes.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers are a frequent indication for advanced biologic dressing products.
`I70.213`	Atherosclerosis of native arteries of extremities with ulceration, right leg	Peripheral arterial disease–related ulcers often require adjunctive membrane therapy after revascularization/debridement.
`T81.89XA`	Other complications of procedures, initial encounter	Post-procedural nonhealing or wound complications that prompt use of advanced membranes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (eg, wound, infection), first 20 sq cm or less	Often performed immediately before membrane placement to prepare a clean wound bed.
`11043`	Debridement, muscle and/or fascia, first 20 sq cm or less	Used for deeper debridement when the wound extends into muscle/fascia prior to membrane application.
`15271`	Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less	A comparable procedure code for biologic dressing application; may be billed for primary application while the HCPCS add-on reports the specific product per sq cm.
`15777`	Implantation of biologic implant (eg, amniotic membrane), trunk or extremity	Used for surgical implantation of biologic membranes in reconstructive workflows alongside the add-on product code.
`13160`	Secondary closure of surgical wound (eg, complicated)	May be performed in conjunction with membrane placement when closure is required after debridement and membrane use.