2025 HCPCS code Q4104
(Active) Effective Date: N/A Skin Substitutes and Biologicals Feed
Integra bilayer matrix wound dressing (BMWD), per square centimeter.
Medical necessity must be established for the use of skin substitutes. This typically involves documenting that standard wound care has been ineffective and that the wound is not healing properly.
In simple words: This code covers a special kind of wound dressing that helps your body grow new skin. It's used for serious wounds like burns or ulcers. The dressing has two layers: one helps new skin grow, and the other protects the wound from germs.
This code represents each square centimeter of Integra bilayer matrix wound dressing, a skin substitute used as a dressing to encourage tissue regeneration. The Integra bilayer matrix wound dressing is a two-layered skin replacement product. It consists of an inner layer of bovine collagen and glycosaminoglycan and an outer layer of silicone. The collagen layer acts as a matrix that promotes the growth of the patient's own cells and blood vessels into the wound to repair the damaged tissue. The silicone layer controls moisture loss and acts as a barrier to bacteria.
Example 1: A patient with a chronic diabetic foot ulcer receives application of Q4104 Integra bilayer matrix wound dressing to facilitate healing and tissue regeneration., Following a full-thickness burn, a patient receives Q4104 Integra bilayer matrix wound dressing to cover the affected area and promote skin regeneration., A patient with a large surgical wound that is not healing well receives Q4104 to encourage faster and more complete closure of the wound.
Documentation should include the size of the wound in square centimeters, the medical necessity for the skin substitute, and the date of application. Supporting documentation such as photographs or measurements of the wound may also be necessary.
** Q-codes are often temporary and may be subject to specific payer policies. It's important to verify coverage with the patient's insurance carrier before applying these skin substitutes. The use of skin substitutes is often considered when other standard wound treatments have failed.
- Specialties:Plastic Surgery, General Surgery, Wound Care, Podiatry, Burn Care
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Skilled Nursing Facility, Home, Other Place of Service