2025 HCPCS code A2004
(Active) Effective Date: N/A Medical and Surgical Supplies Feed
XCelliStem, 1 mg
Yes. Modifier SC is applicable to indicate medical necessity.
Medical necessity for XCelliStem should be supported by documentation indicating that the wound is not healing adequately with standard treatments and that the use of this product is expected to significantly improve healing outcomes.
The provider applies this product to the wound and reports the code per milligram used.
In simple words: XCelliStem is a powder made from pig tissue used to help wounds heal. It's put on injuries like cuts, surgical wounds, or sores to speed up the healing process.
XCelliStem is a powder derived from porcine (pig) material for wound management. It is a proprietary blend of multiple extracellular matrix (ECM) materials, including spleen and lung.It is applied to wounds, such as ulcers, surgical wounds, or trauma wounds, to aid healing.
Example 1: A patient with a chronic diabetic ulcer on the foot is treated with XCelliStem to promote healing., A patient with a surgical wound dehiscence receives application of XCelliStem powder for improved wound closure., XCelliStem is applied after surgical debridement of a large, traumatic wound.
Documentation should include the wound type, size, location, date of application, and the amount (in milligrams) of XCelliStem used. Photographs of the wound before and after application are also helpful.
** XCelliStem is a proprietary blend of multiple ECM source materials derived from porcine spleen and lung.
- Specialties:Wound care, podiatry, plastic surgery, general surgery, dermatology
- Place of Service:Office, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Inpatient Hospital, Skilled Nursing Facility, Nursing Facility, Home,Outreach Site/Street and other places of service where wound care is provided.