HCPCS Q4397: Summit aaa, Per Square Centimeter (Add-on)

HCPCS Level II code Q4397 designates a per-square-centimeter add-on charge for a product or service labeled “Summit aaa,” intended to be billed in addition to a primary procedure. As an add-on HCPCS code, it matters nationally because it affects how adjunctive materials or area-based products are reported alongside primary procedural services and can influence total allowed amounts and billing clarity across providers and payers. Key payers in scope for national consideration include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what this code represents clinically and operationally, the typical sites of service where it applies, and the types of benchmarks and policy elements commonly associated with add-on HCPCS codes. The publication outlines how the code is used in billing workflows, the potential implications for reimbursement when charged per square centimeter, and common documentation points needed to support its use. It also provides a concise overview of payer coverage considerations and the landscape of coding practice for adjunctive, area-measured products. Data not available in the input are noted where applicable.

Billing Code Overview

HCPCS Level II code Q4397 describes Summit aaa, billed per square centimeter as an add-on, listed separately in addition to the primary procedure. This code represents an adjunctive product or service measured by area for use alongside a primary therapeutic or procedural intervention.

Service type: Adjunctive procedural product billed by area (per square centimeter)

Typical site of service: Operative or procedural settings where the primary procedure is performed (e.g., hospital operating room, ambulatory surgical center, or physician office procedure suite)

Clinical Context

A 68-year-old patient with an abdominal aortic aneurysm (AAA) undergoes endovascular aneurysm repair (EVAR) in an outpatient ambulatory surgery center or hospital operating room. During the primary EVAR procedure, an adjunctive device, billed with Q4397 per square centimeter (add-on, list separately), is applied to reinforce aortic wall integrity at the aneurysm landing zone. The clinical workflow includes preoperative imaging (CT angiography), vascular surgery or interventional radiology consultation, informed consent, intraoperative device sizing and deployment, completion angiography, and immediate postoperative monitoring in a post-anesthesia care unit. Typical team members include a vascular surgeon, interventional radiologist, anesthesiologist, circulating nurse, and scrub tech. The typical site of service is an ambulatory surgical center or hospital operating room, with short inpatient observation if indicated for comorbidities or complications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (placeholder)	Rarely used; default when no other modifier applies.
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
`207P00000X`	Vascular Surgery	Primary specialty performing EVAR and adjunctive aortic reinforcement.
`208100000X`	Interventional Cardiology	May assist with endovascular device deployment in some centers.
`2086S0102X`	Interventional Radiology	Common operator for endovascular aneurysm repair and device placement.
`207L0000X`	General Surgery	May perform open or hybrid aortic procedures with adjunctive devices.
`208D00000X`	Diagnostic Radiology	Provides imaging guidance and interpretation during planning and intraoperative imaging.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.3`	Abdominal aortic aneurysm, ruptured	Applies when an AAA is emergent; adjunctive devices may be used during repair.
`I71.4`	Abdominal aortic aneurysm, without rupture	Most common indication for elective EVAR and for use of adjunctive reinforcement devices billed per square centimeter.
`I71.9`	Aortic aneurysm, unspecified site, without rupture	Used when documentation does not specify exact aortic segment but aortic aneurysm treatment is performed.
`I72.3`	Aneurysm of iliac artery	Iliac aneurysms often treated during EVAR; adjunctive devices may be applied at iliac landing zones.
`I77.1`	Stricture of artery	May co-occur when additional reinforcement or patching is needed during endovascular repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34802`	Endovascular repair of infrarenal aortic aneurysm or dissection; using fenestrated or branched stent graft, including delivery and all associated radiologic supervision and interpretation	Primary EVAR technique that may precede or accompany application of an add-on per square centimeter device billed with `Q4397`.
`34812`	Endovascular repair of infrarenal aortic aneurysm; bifurcated stent graft, with or without aorto-uni-iliac conversion, including all radiologic supervision and interpretation	Common primary procedure for AAA; `Q4397` may be billed in addition to this CPT when a reinforcement device is applied.
`36245`	Selective catheter placement, major aortic branch, with diagnostic angiography, including radiological supervision and interpretation	Diagnostic and intraoperative angiography commonly performed before or during EVAR to guide device placement and use of adjunctive materials.
`74240`	Radiologic supervision and interpretation, abdominal aorta and iliac arteries, with contrast, CT angiography, initial	Preoperative CTA used for sizing and planning the area (square centimeters) requiring the add-on device billed with `Q4397`.
`37184`	Transcatheter placement of an intravascular stent(s), (non-coronary), percutaneous, each vessel; initial vessel	Stent placement in aorto-iliac vessels that may be performed before, during, or after EVAR as part of the overall endovascular strategy involving `Q4397`.

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Summary & Overview