Q4369 Amnioplast (HCPCS) Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS Q4369: Amnioplast per Square Centimeter

HCPCS Level II code Q4369 represents an add-on billing code for amnioplast material billed per square centimeter, used when amniotic membrane is applied as an adjunct to a primary surgical or wound-care procedure. As an add-on code, Q4369 is reported in addition to the primary procedure code to capture the incremental resource use and material costs for amnioplast application. Nationally, precise reporting of add-on codes like Q4369 affects clinical documentation, facility and professional billing workflows, and aggregate utilization measures for advanced biologic wound treatments.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise description of the code and clinical context, payer coverage considerations, common modifiers and billing practice notes, and related service-line implications for surgical and wound-care settings. The publication summarizes how Q4369 is used across typical sites of service (operating rooms, outpatient procedure suites, and inpatient surgical settings) and highlights documentation elements needed to support add-on reporting. Data not available in the input is noted where applicable. This overview supports billing managers, coding professionals, and policy analysts seeking a clear, national-level reference for Q4369.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareQ4369HCPCS Level IIamnioplastadd-on codewound caresurgical servicesbiologic graftsbilling guidance

Billing Code Overview

HCPCS Level II code Q4369 describes Amnioplast 3, billed per square centimeter and is designated as an add-on, to be listed separately in addition to the primary procedure. The service involves application or reconstruction of amniotic membrane material over a wound or surgical site and is typically performed as an adjunct to a primary surgical or wound-care procedure.

Service Type: Add-on surgical/wound care procedure

Typical Site of Service: Operating room or procedure suite; outpatient surgical center; inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a pregnant person in the second or third trimester requiring surgical repair of an amniotic membrane defect or localized amniotic sac reconstruction during an obstetric procedure. This add-on service, billed as Q4369 per square centimeter, is performed in conjunction with a primary operative procedure such as fetal surgery, cesarean delivery with intrauterine repair, or complex placental/uterine repair when focal amnioplasty is needed to restore or reinforce the amniotic membrane. The patient presents to an operating room in a hospital or specialized maternal-fetal surgery center. Preoperative evaluation includes obstetric ultrasound to localize the defect, maternal and fetal monitoring, and informed consent that the repair is an adjunct to the primary procedure. Intraoperatively, the primary surgeon identifies the area of amniotic membrane compromise, measures the surface area requiring repair, and performs the amnioplasty using suturing, biologic graft, or sealant. Documentation must specify the measured square centimeters repaired and reference the primary procedure. Typical recovery is monitored in a post-anesthesia care unit with continued fetal monitoring and obstetric follow-up; the service is reported in addition to the principal procedure when criteria for separate reporting are met. Typical site of service: hospital operating room, ambulatory surgery center, or maternal-fetal surgery center. Service type: surgical add-on repair of amniotic membrane per square centimeter (Q4369). Typical patient scenario: mid-to-late gestation patient undergoing cesarean or fetal intervention with a localized amniotic membrane defect requiring measured amnioplasty adjunctive to the primary procedure.

Coding Specifications

Modifier	Description	When to Use

HCPCS Q4304: Grafix Plus, Biologic Graft per Square Centimeter

HCPCS-Q4183-SURGIGRAFT-PER-SQ-CM-ADD-ON

HCPCS Q4183: Surgigraft, per square centimeter (add-on)

HCPCS-Q5119-RITUXIMAB-PVVR-RUXIENCE-10MG-INJECTION

HCPCS Level II Q5119: Injection, rituximab-pvvr (Ruxience), 10 mg

HCPCS-Q4332-AXOLOTL-DUALGRAFT-PER-SQCM

HCPCS Q4332: Axolotl Dualgraft, Per Square Centimeter

HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

HCPCS Q0092: Set-up of Portable X-Ray Equipment

HCPCS-Q4014-GAUNTLET-CAST-FIBERGLASS-ADULT

HCPCS Q4014: Gauntlet Cast, Forearm and Hand, Fiberglass, Adult

HCPCS-Q4260-SIGNATURE-APATCH-PER-SQUARE-CENTIMETER

HCPCS Q4260: Signature apatch, Per Square Centimeter

HCPCS-Q4015-PEDIATRIC-GAUNTLET-PLASTER-CAST-SUPPLY

HCPCS Q4015: Pediatric Plaster Gauntlet Cast Supply

HCPCS-Q0245-BAMLANIVIMAB-ETESEVIMAB-INJECTION-2100MG

HCPCS Q0245: Bamlanivimab and Etesevimab Injection, 2100 mg

HCPCS-Q4006-LONG-ARM-FIBERGLASS-CAST-ADULT

HCPCS Q4006: Long Arm Fiberglass Cast Supply, Adult

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Taxonomy Code	Specialty	Notes
207V00000X	Maternal-Fetal Medicine	Specialists in fetal surgery and high-risk obstetrics who commonly perform or coordinate amnioplasty during fetal interventions.
207P00000X	Obstetrics & Gynecology	General obstetric surgeons who perform cesarean delivery and intraoperative repairs including amnioplasties.
208U00000X	Pediatric Surgery	Surgeons involved in fetal surgical teams for intrauterine procedures who may assist with membrane repairs.
2086S0075X	Surgical Subspecialty (Fetal Surgery)	Subspecialists participating in complex fetal interventions and membrane reconstruction.
363L00000X	Perinatology	Clinicians providing perinatal care and coordination for procedures requiring amnioplasty.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O41.03`	Polyhydramnios, second trimester	Excess amniotic fluid may be associated with membrane defects or fetal anomalies prompting interventions that include amnioplasty.
`O41.13`	Polyhydramnios, third trimester	Late-gestation fluid disorders can be present in patients undergoing operative interventions where membrane repair is required.
`O71.0`	Third-stage hemorrhage — retained placenta or membranes	Situations with retained membranes or membrane compromise during delivery may necessitate localized membrane repair.
`O34.2`	Maternal care for abnormality of pelvic organs, antepartum condition	Anatomical abnormalities discovered intraoperatively may require concurrent amniotic membrane management.
`O36.8XX0`	Maternal care for other known or suspected fetal problems, not applicable or unspecified — fetus unspecified	Fetal conditions requiring intrauterine procedures often lead to adjunctive amnioplasty during fetal surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`59510`	Routine obstetric care including antepartum care, cesarean delivery, and postpartum care	Primary cesarean delivery often serves as the principal operative procedure to which `Q4369` is appended when amnioplasty is performed during the same operative session.
`59620`	Routine obstetric care including antepartum care, vaginal delivery (after previous cesarean delivery), and postpartum care, with cesarean delivery	Alternative primary obstetric code when repeat cesarean scenarios involve concurrent amnioplasty.
`59640`	Attempted vaginal delivery after previous cesarean delivery, including cesarean delivery, when performed	May be the primary operative code in trials of labor culminating in cesarean with adjunct amnioplasty.
`59120`	Fetal monitoring during labor and delivery (noninvasive fetal surveillance) — initial	Perioperative fetal monitoring code commonly used in the operative workflow before and after an amnioplasty performed during obstetric surgery.
`76942`	Ultrasonic guidance for needle placement (e.g., amniocentesis)	Ultrasound guidance may be used intraoperatively to localize amniotic defects prior to performing `Q4369` amnioplasty.
`54535`	Repair of urethral or bladder injury (example pelvic repair) — included as illustrative pelvic surgical repair codes	Other concomitant pelvic or uterine repair CPTs may be performed in the same operative session; when performed, `Q4369` is billed in addition as the measured amnioplasty component.

`00`	No modifier — standard reporting	Use when no special circumstances apply and the service is billed per usual conventions for an add-on code.
`22`	Increased procedural services	Use when the amnioplasty required substantially greater work or complexity than typical (document rationale for increased work).
`52`	Reduced services	Use when the amnioplasty was partially reduced or not completed as originally planned (document reason and extent).
`53`	Discontinued procedure	Use when the planned amnioplasty was started but discontinued for patient safety or emergent reasons (document termination reason).
`59`	Distinct procedural service	Use when the amnioplasty is performed at a distinct anatomic site or qualifies as separate from the primary procedure (documentation must support distinctness).
`50`	Bilateral procedure	Use when comparable amnioplasty repair is performed on both sides of a bilateral anatomic field and payer requires bilateral reporting (document bilateral nature and measurements).
`76`	Repeat procedure by same physician	Use when a repeat amnioplasty is performed by the same physician during the global period.
`77`	Repeat procedure by another physician	Use when a repeat amnioplasty is performed by a different physician during the global period.
`RT`	Right side	Use when the amnioplasty is localized to the right anatomic area and payer requires laterality coding.
`LT`	Left side	Use when the amnioplasty is localized to the left anatomic area and payer requires laterality coding.

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