2025 HCPCS code Q4168
(Active) Effective Date: N/A Skin Substitutes and Biologicals - Skin Substitutes and Biologicals Q4100-Q4310 Temporary Codes Q0035-Q9992 Feed
AmnioBand™, 1 mg: Lyophilized placental matrix allograft used as a wound care scaffold or for replacing damaged integumental tissue.
Medical necessity for AmnioBand™ generally involves chronic wounds that haven't healed with standard treatments, such as diabetic foot ulcers, venous leg ulcers, or pressure ulcers. Payer policies may have specific criteria, such as wound size and duration, that must be met for coverage. It's important to check individual payer policies for details.
- Temporary Codes Q0035-Q9992
- Temporary Codes (Q0035-Q9992) -> Skin Substitutes and Biologicals (Q4100-Q4310)
In simple words: AmnioBand is a special wound covering made from donated placental tissue. It's used to help heal difficult wounds like diabetic foot ulcers, leg ulcers, and pressure sores. This code covers the cost of 1 milligram of the material.
AmnioBand™ is a lyophilized placental matrix allograft, supplied in 1 mg units. It is used as a wound care scaffold or for the replacement of damaged or inadequate integumental tissue. It is derived from human donated amnion membrane from the inner lining of the placenta. Indicated uses include diabetic foot ulcers, venous leg ulcers, pressure ulcers, or irregularly-shaped or crevassing wounds. This code represents the allograft material only and does not include the application procedure.
Example 1: A patient with a chronic diabetic foot ulcer, unresponsive to standard therapy, receives 120mg of AmnioBand™ as a wound scaffold. Q4168 is reported 120 times. , A patient with a venous leg ulcer receives 80mg of AmnioBand™ to promote healing. The code Q4168 is reported 80 times to cover the amount of allograft used. Application procedure will be coded separately, A patient with an irregularly shaped pressure ulcer requires 40 mg of AmnioBand™ to fill and cover the wound bed. 40 units of Q4168 are reported. Separate code will be used for placement.
Documentation must support the medical necessity of AmnioBand™, specifying the type of wound, its size, duration, previous treatments, and the quantity of AmnioBand™ used (in milligrams). The patient's diagnosis (e.g., diabetic foot ulcer) and relevant medical history should also be clearly documented.
- Specialties:Podiatry, Wound Care, General Surgery, Plastic Surgery, Dermatology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Wound Care Clinic, Skilled Nursing Facility