Summary & Overview
HCPCS Q4365: Amnio Burgeon Dual-Layer Membrane, per sq cm
HCPCS Level II code Q4365 represents an amnio burgeon dual-layer membrane supplied and billed per square centimeter as an add-on item to a primary procedure. This code designates a biologic implant product used in surgical tissue reconstruction or wound repair, where the membrane supports healing and tissue regeneration. Nationally, products billed under this code matter because they affect procedure-level supply costs and influence reimbursement for complex reconstructive and wound-care interventions.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical role and service setting, plus what to expect in a full analysis: utilization benchmarks, reimbursement policy considerations, coverage policies across major payers, and clinical context for use as an adjunctive biologic graft.
This summary presents what Q4365 denotes, the likely clinical scenarios and sites of service where the membrane is used, and the payers typically involved in coverage decisions. Data not available in the input will be identified in the detailed sections of the full publication.
Billing Code Overview
HCPCS Level II code Q4365 describes an amnio burgeon dual-layer membrane, billed per square centimeter as an add-on item to be listed separately in addition to the primary procedure. The service type is a biologic implant/graft product used to support tissue repair and healing. The typical site of service for this product is an operating room or procedural suite within hospital outpatient departments, ambulatory surgery centers, or other procedural settings where surgical tissue reconstruction or wound repair is performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with a chronic non-healing wound (for example, a diabetic foot ulcer or surgical wound with failed healing) presents to a wound care clinic or outpatient surgical center for advanced biologic graft therapy. After assessment, conservative measures (debridement, offloading, local wound care, infection control) have not achieved progress. The multidisciplinary team (podiatry, plastic surgery, or wound care specialist) plans application of an amniotic membrane graft as an adjunct to standard wound procedures.
The procedure typically occurs in an outpatient wound care clinic, ambulatory surgery center, or hospital outpatient department. The workflow includes wound measurement and debridement, selection and sizing of the Q4365 amnio burgeon dual-layer membrane (billed per square centimeter as an add-on), application of the membrane to the prepared wound bed, fixation with sutures or adhesive, and dressing. Documentation includes wound size in cm2, indication, concurrent primary procedure (such as debridement or closure), product lot and quantity, and provider performing the application. The Q4365 code is reported in addition to the primary wound procedure and appended with appropriate modifiers to reflect circumstances (e.g., bilateral, reduced services, unusual procedural services). Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare, each requiring documentation of medical necessity, wound measurements, and concurrent procedure linkage when submitting the add-on product code.
Coding Specifications
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