Q4425 HCPCS Reimbursement & Benchmarks

HCPCS Level II code Q4425 designates an add-on billing code for Revive tl measured per square centimeter. As an add-on supply code, it is billed in addition to a primary procedure when a topical or surface-applied product is used and priced by surface area. Nationally, such codes matter because they affect how providers report and recover costs for consumable products used during outpatient procedures and treatments.

Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and billing context for Q4425, guidance on typical sites of service, and what to expect in payer coverage reviews. The publication outlines benchmarks and comparative policy considerations relevant to add-on HCPCS Level II supply codes, and highlights how billing by area unit can influence documentation and claim submission workflows.

This summary provides the clinical framing and national relevance of Q4425, along with an overview of payer coverage landscape and the types of benchmarks and policy updates readers will encounter. Data not available in the input is noted where applicable.

Billing Code Overview

HCPCS Level II code Q4425 describes Revive tl, per square centimeter (add-on, list separately in addition to primary procedure). The code represents an add-on supply or material billed in addition to a primary procedure for products measured and reported by surface area (per square centimeter).

Service type: Topical or surface-applied medical product or device billed per area unit.

Typical site of service: Procedures or treatments where a topical or surface device is applied, such as outpatient clinics, ambulatory procedure centers, or other outpatient treatment settings.

Data not available in the input.

Clinical Context

A typical patient is an adult with a chronic wound (for example, a non-healing diabetic foot ulcer or venous leg ulcer) presenting to a wound care clinic or outpatient surgical center for adjunctive topical therapy. The clinician measures the wound surface area in square centimeters, debrides devitalized tissue as needed, and applies the topical bioactive product “Revive TL” to the wound bed. The service is billed as an add-on per square centimeter when provided in addition to a primary wound procedure (such as debridement or grafting). Typical workflow: wound assessment and measurement, wound bed preparation (cleansing and debridement), application of Revive TL to the measured area, dressing application, documentation of product name, lot number, area treated (cm2), and accompanying primary procedure and diagnosis codes, and patient education on wound care and follow-up.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When the add-on topical product is performed in a distinct session or separate anatomic site from the primary procedure
`XE`	Separate Encounter

Taxonomy Code	Specialty	Notes
`163W00000X`	Wound Care Specialist	Clinicians focused on complex wound management and application of advanced topical products
`207Q00000X`	Surgeon	General or specialty surgeons who perform debridement, grafting, and apply adjunctive topical products
`181100000X`	Dermatology	Dermatologists treating chronic skin ulcers and applying topical biologic or bioactive dressings
`207K00000X`	Plastic Surgeon	Plastic surgeons performing reconstructive procedures and adjunctive topical therapies
`363A00000X`	Nurse Practitioner (Wound Care)	Advanced practice clinicians who perform wound assessment and apply topical products

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes-related foot ulcers are a common indication for advanced topical therapies like `Revive TL` to promote healing
`I83.013`	Varicose veins of right lower extremity with ulcer of thigh	Venous stasis ulcers often require adjunctive topical products after debridement and compression
`L97.419`	Non-pressure chronic ulcer of right lower leg with unspecified severity	Chronic lower extremity ulcers are typical wounds treated with topical bioactive agents
`L97.509`	Non-pressure chronic ulcer of unspecified part of left lower leg with unspecified severity	Represents chronic ulcers where topical adjuncts are applied per cm2
`M79.671`	Pain in right foot	Pain is a common symptom prompting wound evaluation and topical treatment

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue, first 20 sq cm or less	Common primary procedure before application of `Revive TL` to prepare wound bed
`11043`	Debridement muscle and fascia, first 20 sq cm or less	Used when deeper debridement is performed prior to topical product application
`97602`	Debridement (e.g., high pressure waterjet) with topical wound care; non-selective	Performed in wound care clinics; may precede add-on topical application
`15271`	Application of skin substitute graft to trunk, arms, legs; first 100 sq cm or less, non-meshed	When application of a biologic skin substitute is the primary procedure and `Revive TL` is used adjunctively
`29580`	Application of short leg splint (below knee)	Example of adjunctive immobilization measure following certain lower extremity wound procedures where topical agents are also applied
`99070`	Supplies and materials (e.g., dressings), non-durable medical equipment, used more than usual	Billed when additional dressing supplies or materials accompany the topical product application

OpenPayer

Summary & Overview

HCPCS Q4425: Revive tl, Per Square Centimeter (Add-on)