Q4380 Advograft HCPCS: Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS Q4380: Advograft per Square Centimeter Graft

HCPCS Level II code Q4380 denotes billing for Advograft measured per square centimeter as an add-on product to a primary surgical procedure. The code matters nationally because biologic graft products represent a growing segment of surgical supply costs and have implications for procedure-level pricing, utilization monitoring, and payer coverage policies. Coverage decisions and coding precision affect hospital reimbursement and billing compliance when these grafts are used alongside primary operative services.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on how the code is used in clinical workflows, typical sites of service, and the significance of per-unit (per cm2) billing for graft materials. The analysis also outlines common modifiers used with this type of add-on billing and notes where input data is unavailable.

This publication provides benchmarks and policy-relevant information to inform billing accuracy, payer engagement, and coding documentation practices. It offers a concise reference for clinicians, coders, and administrators seeking a national overview of how Q4380 is applied in surgical settings and why precise unit-based billing for biologic grafts matters for reimbursement and compliance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4380HCPCS Level IIAdvograftgraftsurgical suppliesadd-on codeoperative billinghospital outpatientambulatory surgery

Billing Code Overview

HCPCS Level II code Q4380 describes Advograft one, per square centimeter (add-on, list separately in addition to primary procedure). This code represents a graft product billed per square centimeter when used as an adjunct to a primary surgical procedure. The service type is a biologic graft application used in surgical wound or tissue repair. The typical site of service is an operating room or surgical suite in an inpatient or outpatient hospital setting, and may also be used in ambulatory surgical centers depending on the primary procedure.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a full-thickness traumatic or chronic wound of the lower extremity (for example, a non-healing diabetic foot ulcer, venous stasis ulcer, or large traumatic skin loss) requiring placement of a skin substitute. The surgical team — often a podiatric or vascular surgeon with a plastic surgery or wound care specialist — performs debridement of devitalized tissue, achieves hemostasis, and prepares the wound bed. After appropriate wound bed preparation and irrigation, a measured area of the biologic graft product Advograft is applied to the wound surface and secured with sutures, staples, or biologic adhesive. The procedure is billed as an add-on supply per square centimeter using Q4380 in addition to the primary operative or wound repair CPT code. Typical workflow includes preoperative evaluation, intraoperative debridement and graft application, and postoperative wound care instructions with scheduled clinic follow-up for graft take assessment and dressing changes.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (standard billing)	Use when no special reporting modifier applies and the add-on graft is billed under routine circumstances.
`22`

HCPCS Level II Q4028: Pediatric Hip Spica Fiberglass Cast Supplies

HCPCS-Q4011-PEDIATRIC-SHORT-ARM-PLASTER-CAST-SUPPLIES

HCPCS Q4011: Pediatric Short Arm Plaster Cast Supplies

HCPCS-Q4353-XCEED-TL-MATRIX-WOUND-MANAGEMENT-PER-SQ-CM

HCPCS Q4353: Xceed tl Matrix, Wound Management Add-On

HCPCS-Q0507-EXTERNAL-VENTRICULAR-ASSIST-DEVICE-SUPPLY

HCPCS Q0507: Supply or Accessory for External Ventricular Assist Device

HCPCS-Q0483-VAD-MONITOR-DISPLAY-MODULE-REPLACEMENT

HCPCS Q0483: Monitor/Display Module for Ventricular Assist Device Replacement

HCPCS-Q0115-POST-COITAL-MUCUS-EXAMINATION

HCPCS Q0115: Post-coital Vaginal or Cervical Mucus Examination

HCPCS-Q4355-ABIOMEND-XPLUS-MEMBRANE-PER-CM-SURGICAL-ADJUNCT

HCPCS Q4355: Abiomend xplus Membrane, Per Square Centimeter

HCPCS-Q0503-BATTERY-PNEUMATIC-VENTRICULAR-ASSIST-DEVICE-REPLACEMENT

HCPCS Q0503: Battery for Pneumatic Ventricular Assist Device, Replacement

HCPCS-Q9973-EPOETIN-BETA-1-MCG-NON-ESRD-INJECTION

HCPCS Q9973: Injection, Epoetin Beta, 1 mcg (Non-ESRD)

HCPCS-Q0517-PHARMACY-FEE-HIV-PRE-EXPOSURE-PROPHYLAXIS-60-DAY

HCPCS Q0517: Pharmacy Supplying Fee for HIV Pre-Exposure Prophylaxis

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Taxonomy Code	Specialty	Notes
`207P00000X`	Podiatry	Podiatric surgeons commonly apply skin substitutes for diabetic foot ulcers and traumatic wounds of the foot.
`207L00000X`	Vascular Surgery	Vascular surgeons manage ischemic or venous wounds and perform graft applications following revascularization or debridement.
`208200000X`	General Surgery	General surgeons apply biologic grafts in soft tissue and extremity wounds during reconstructive procedures.
`208C00000X`	Plastic Surgery	Plastic and reconstructive surgeons place skin substitutes for complex wounds and soft tissue reconstruction.
`261QP2400X`	Wound Care/Hyperbaric Medicine	Wound care specialists coordinate graft selection and postoperative wound management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L97.421`	Non-pressure chronic ulcer of right calf with fat layer exposed	Chronic lower-extremity ulceration frequently requires biologic grafts such as Advograft to promote healing.
`L97.422`	Non-pressure chronic ulcer of left calf with fat layer exposed	Same clinical relevance as above for contralateral limb.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers are a common indication for advanced wound therapies including per cm2 biologic graft application.
`I83.013`	Varicose veins of right lower extremity with ulceration	Venous stasis ulcers may require debridement and grafting to achieve closure.
`S81.811A`	Open wound of right lower leg, initial encounter	Traumatic open wounds with significant tissue loss often receive biologic grafts as part of reconstruction.
`T79.A11A`	Traumatic compartment syndrome of right lower leg, initial encounter	Complex soft-tissue injuries after trauma may use grafts during staged reconstruction and closure.
`L89.322`	Pressure ulcer of left ischial tuberosity, stage 3	Pressure injuries with full-thickness tissue loss can be treated with biologic grafts to facilitate healing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (first 20 sq cm or less)	Common preceding procedure to prepare the wound bed prior to application of `Q4380`.
`15734`	Muscle, myocutaneous or fasciocutaneous flap, trunk; first or second stage	May be performed in conjunction with or instead of graft placement for large complex wounds where `Q4380` is used as an adjunct.
`15271`	Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% BSA	Alternative or complementary grafting technique; `Q4380` is billed as an add-on biologic graft per cm2 in addition to primary autografting when used.
`97597`	Debridement (e.g., high pressure water jet, sharp), open wound, non-selective debridement; initial wound, first 20 sq cm or less	Outpatient debridement codes commonly used during wound bed preparation before application of an advanced graft product like `Q4380`.
`15275`	Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less	A primary skin substitute application CPT that may be reported alongside procedures where `Q4380` is billed as an add-on supply.

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