Clinical Context
A typical patient is an adult or pediatric surgical candidate undergoing reconstruction or resurfacing of a soft-tissue defect (e.g., skin or mucosal surface) in which a biologic neothelial graft material is applied. The procedure billed with Q4389 is an add-on, square-centimeter–based supply charge for neothelium material (4 layers or more per cm²) used in conjunction with a primary excision, debridement, or reconstructive procedure.
A realistic workflow: the patient presents to an outpatient ambulatory surgery center or hospital operating room with a chronic non-healing wound, post-oncologic resection defect, or complex burn/scar contracture requiring biologic grafting. The surgeon performs the primary procedure (e.g., excision, debridement, or flap coverage) and places the neothelium graft to enhance epithelialization. Intraoperative documentation includes the measured area in square centimeters, number of layers (≥4), lot numbers, and that the graft is an add-on supply separate from the primary procedure. Billing uses the primary surgical CPT code for the operative procedure and reports Q4389 as an add-on per square centimeter of the neothelium product. Typical sites of service are ambulatory surgery centers, hospital outpatient departments, and inpatient operating rooms. Common clinical scenarios include reconstruction after wide local excision of skin malignancy, chronic venous or diabetic ulcer repair, and complex burn wound reconstruction where biologic epithelial graft material is indicated.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
12001 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.5 cm or less | May be performed prior to or instead of grafting for small defects; not commonly paired when neothelium is used for larger or deeper wounds. |
15271 | Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less, or per donor site | Commonly used for biologic/skin substitute placement; may be billed as primary procedure when applicable and used alongside or in place of Q4389 depending on product and payer rules.
15330 | Split-thickness autograft, first 100 sq cm or less, trunk, arms, legs; harvest and application | Performed when autograft is used; may precede or be combined with biologic neothelium when coverage strategy requires both.
14060 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck; defect 10 sq cm or less | Reconstructive flap procedures that may accompany or obviate the need for neothelium grafting depending on defect size and depth.
13131 | Scar revision, complicated; each additional 5 sq cm | Scar excision/revision procedures followed by grafting or skin substitute application for resurfacing.
97605 | Negative pressure wound therapy (NPWT), initial; simple or complex | Frequently used postoperatively to manage wounds with biologic grafts to promote adherence and healing.
A6530 | Biological dressing, per square centimeter (example HCPCS supply) | Supply-level codes for biologic dressings/sheets that may be used in same workflow; payer-specific billing interplay with Q4389 may apply.