Summary & Overview
HCPCS Q4376: Duograft aa, Per Square Centimeter (Add-On)
HCPCS Level II code Q4376 designates Duograft aa billed per square centimeter as an add-on supply code that is submitted in addition to a primary procedure. This code is used to report a biologic graft product when billing for graft material by area, enabling itemized capture of graft supplies separate from the primary surgical or wound procedure. Nationally, such add-on HCPCS codes matter because they affect how graft products are documented and reimbursed across varied surgical and wound-care settings.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer mix considered in the analysis. The publication summarizes billing characteristics, common modifiers, and how Q4376 functions as an add-on supply code in claims workflows.
The report highlights benchmarks and policy-relevant points for national payers and provider billing teams: how add-on product codes are reported alongside primary procedures; implications for unit-based billing by square centimeter; and where to expect variability in payer coverage and coding adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code Q4376 represents Duograft aa billed per square centimeter as an add-on, list separately in addition to primary procedure. The code applies to billing for the product Duograft aa with units measured by square centimeter.
Service type: Graft product / biologic graft application
Typical site of service: Operative settings or procedure locations where grafts are applied (e.g., operating room, ambulatory surgery center, wound care procedure rooms)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a full-thickness or complex soft-tissue wound of the lower extremity (for example, chronic diabetic foot ulcer with exposed tendon or bone) after debridement and failed conservative therapy. The surgical team — often a reconstructive plastic surgeon or podiatric surgeon — evaluates the wound in the operating room, performs thorough irrigation and debridement, and prepares the wound bed for placement of an acellular dermal matrix. Q4376 represents billing for Duograft aa measured and billed per square centimeter as an add‑on product in addition to the primary procedure. The clinical workflow: preoperative assessment and optimization (e.g., glycemic control, vascular evaluation), operative debridement and wound bed preparation, sizing and placement of the Duograft allograft to cover exposed structures, securing the graft and applying appropriate dressing or negative pressure wound therapy, and postoperative wound checks with staged dressing changes and possible secondary procedures (skin graft or flap) depending on graft take and wound evolution.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default code reporting | Use when no special circumstances apply to the service. |