Summary & Overview
HCPCS Q4367: Amniocore SL, Amniotic Membrane per cm2
HCPCS Level II code Q4367 designates Amniocore SL, an amniotic membrane product billed per square centimeter as an add-on to a primary procedure. This code captures the additional supply cost when biologic amniotic tissue is used to support wound healing or tissue repair during an index surgical or outpatient procedure. Nationally, use of product-specific add-on HCPCS codes matters because they affect procedure-level reimbursement, supply accounting, and clinical documentation across diverse care settings.
Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, the service types and typical sites of service where it is applied, and the common modifiers that appear on claims (provided separately). The publication also summarizes benchmarking expectations, coding considerations for grouping with primary procedures, and policy implications for coverage and reimbursement when biologic grafts are used as adjunctive therapy.
The content provides practical coding context and policy-consequence highlights for revenue cycle managers, clinical coders, and payer policy analysts assessing claims that include amniotic membrane products billed with Q4367.
Billing Code Overview
HCPCS Level II code Q4367 describes Amniocore SL, billed per square centimeter as an add-on item to be listed separately in addition to a primary procedure. The service represents application or placement of an amniotic membrane product (Amniocore SL) measured and billed by surface area.
Service type: Biologic graft/derivative application
Typical site of service: Outpatient ambulatory settings, outpatient surgical centers, and hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A patient with a chronic, non-healing or complex wound (for example a full-thickness diabetic foot ulcer or a radiation-induced soft tissue wound) is treated in an outpatient wound care or surgical clinic. After wound bed preparation, debridement, and hemostasis, the clinician applies an amniotic membrane-derived tissue product billed as Q4367 on a per-square-centimeter basis as an adjunct to promote healing. The procedure is performed at a typical ambulatory wound care center, outpatient surgical center, or hospital outpatient department. The team documents wound measurements, preparation steps (sharp, enzymatic, or mechanical debridement), any local anesthesia or sedation, and the square centimeters of product placed. Common clinical workflow steps include wound assessment, cleansing, debridement, application of Q4367 to the prepared wound, fixation/dressing, and post-application instructions and follow-up wound assessments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special modifier applies to the service for standard reporting |
| 22 | Increased procedural services | Use when the service required substantially greater work than typical (document intensity/complexity)