Summary & Overview
HCPCS Q4389: Neothelium 4l+ per Square Centimeter (Add-on)
HCPCS Level II code Q4389 designates billing for Neothelium 4l+ measured per square centimeter as an add-on supply to be reported in addition to a primary procedure. This code captures surface-area–based charges for a biologic or tissue product used during operative or procedural care and matters for national providers because it affects how implantable biologics are documented and reimbursed across settings. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the code's clinical intent and billing context, payer coverage scope, and common operational considerations for reporting add-on, per-area biologic products. The publication summarizes benchmark considerations for pricing and claim submission, outlines typical sites of service where the code applies, and flags areas where payers commonly apply review or coding edits. It provides a national perspective useful for coding staff, revenue cycle managers, and clinicians involved in procedures that use tissue-derived products.
Billing Code Overview
HCPCS Level II code Q4389 represents Neothelium 4l+, billed per square centimeter as an add-on code to be listed separately in addition to a primary procedure. The descriptor indicates this is a charge for a biologic or tissue-derived product measured by surface area rather than a standalone treatment.
Service type: Biologic/tissue product billing, per area unit
Typical site of service: Operative or procedural settings where tissue grafts or biologic implants are applied, such as hospital operating rooms or ambulatory surgical centers.
Data not available in the input.
Clinical & Coding Specifications
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.
Coding Specifications
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