Summary & Overview

HCPCS Q4395: Acelagraft per Square Centimeter, Add-on Supply

HCPCS Level II code Q4395 designates Acelagraft billed per square centimeter as an add-on supply to be reported in addition to a primary surgical or wound-reconstruction procedure. It identifies the use of a biologic graft product applied by area, which has implications for coding accuracy, supply cost reporting, and clinical documentation in operative and procedural care settings. Nationally, product-based add-on codes like Q4395 affect facility supply charges, payer coverage determinations, and quality tracking for grafting procedures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, guidance on where the service is typically provided, and what to expect when submitting claims that include this add-on supply code. The publication summarizes common modifiers and administrative considerations, highlights payer coverage patterns and benchmarking topics, and outlines documentation elements relevant to coding Acelagraft by surface area. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ4395HCPCS Level IIAcelagraftskin substitutegraftadd-on codeoperative supplieswound reconstruction

Billing Code Overview

HCPCS Level II code Q4395 represents Acelagraft, billed per square centimeter as an add-on, listed separately in addition to the primary procedure. This code is used to report the application of Acelagraft, a biologic graft product, measured and billed by surface area.

Service type: Biologic graft material application / skin substitute product

Typical site of service: Operative settings or procedure suites where grafting or wound reconstruction is performed, including hospital outpatient departments, ambulatory surgery centers, and other procedural care locations.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a chronic, non-healing full-thickness cutaneous wound (for example, a diabetic foot ulcer or a large traumatic skin loss) being evaluated in an outpatient wound care clinic or ambulatory surgical center. The treating clinician — commonly a wound care specialist, plastic surgeon, or podiatrist — performs sharp debridement and wound bed preparation followed by application of Q4395 (Acelagraft, charged per square centimeter) as an adjunctive biologic skin substitute to promote closure. The product is supplied in square-centimeter units and billed as an add-on Q code in addition to the primary procedure that provides wound management or closure (for example, debridement, wound dressing, or closure procedures).

Typical workflow:

The patient presents for evaluation of a non-healing wound; history, vascular and infection assessment, and offloading are addressed.
Baseline wound measurements and photographs are documented.
Procedural consent is obtained for debridement and biologic application.
Under appropriate anesthesia, the clinician performs debridement and hemostasis, measures the wound area, and prepares the graft according to manufacturer instructions.
Q4395 is applied to the wound bed and secured per protocol; dressings and follow-up plan are provided.
Post-procedure visits document graft take, wound measurement changes, and any complications; additional units of Q4395 may be billed for repeat applications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard service	Use when no special circumstances apply and the service is reported normally.
`22`	Increased procedural services	Use when work or resources required are substantially greater than normally required for the primary procedure to which `Q4395` is an add-on.
`52`	Reduced services	Use when the service is partially reduced or not provided to the full extent.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`NU`	New equipment	Use when the item supplied is new and not reprocessed/reused (often required by payors for supply tracking).
`RR`	Rental	Use when the supplied device or biologic is furnished on a rental basis (rare for grafts but included for completeness).
`UE`	Left upper extremity	Use when laterality reporting is required and the graft is applied to the left upper extremity.
`RE`	Right upper extremity	Use when laterality reporting is required and the graft is applied to the right upper extremity.
`LT`	Left side	Use when laterality reporting is required (general left-side designation).
`RT`	Right side	Use when laterality reporting is required (general right-side designation).

Taxonomy Code	Specialty	Notes
`207Q00000X`	Plastic Surgery	Commonly performs complex wound reconstruction and biologic graft placement.
`2080P0208X`	Podiatry	Frequently treats diabetic foot ulcers and performs graft applications on lower extremities.
`208000000X`	General Surgery	Manages traumatic wounds and soft-tissue reconstruction with skin substitutes.
`3336C0001X`	Wound Care Specialist	Clinicians focused on advanced wound therapies and biologic applications.
`207L00000X`	Dermatology	Performs skin grafting and biologic applications for complex dermatologic wounds.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Frequently associated with chronic non-healing foot wounds where `Q4395` may be applied.
`L97.423`	Non-pressure chronic ulcer of left ankle with unspecified severity	Represents a common chronic lower-extremity ulcer location treated with biologic grafts.
`S81.811A`	Open wound of right lower leg, initial encounter	Traumatic open wounds requiring grafting and adjunctive biologics.
`T79.A11`	Nonhealing surgical wound of right lower leg	Post-surgical nonhealing wounds may be treated with skin graft substitutes.
`L89.323`	Pressure ulcer of left ankle, stage 3	Advanced pressure ulcers often require biologic therapies to promote closure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (first 20 sq cm or less)	Often billed for surgical wound bed preparation performed immediately prior to application of `Q4395`.
`11043`	Debridement, muscle and/or fascia (first 20 sq cm or less)	Used when deeper debridement is required before graft application.
`15271`	Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less	A primary procedure code for placement of skin substitute products; may be reported in conjunction with `Q4395` when clinically appropriate.
`15275`	Application of skin substitute graft to foot, first 25 sq cm or less	Relevant for lower-extremity wounds where `Q4395` is used as an adjunctive per-square-centimeter graft material.
`97597`	Debridement (eg, high pressure waterjet) first 20 sq cm, outpatient	May be used for non-surgical debridement prior to biologic application in the clinic setting.