HCPCS code Q4116 is commonly used in wound care, surgical reconstruction, and dermatologic procedures to report the use of AlloDerm, a biologic skin substitute. This code is frequently searched by providers, coders, and billers seeking clarity on billing rules, unit calculation, coverage, and documentation requirements.
This guide explains what Q4116 is, how it’s used, and how to bill it correctly.
Related: What are Q code in Medical Billing?
What Is HCPCS Code Q4116?
Q4116 is a HCPCS Level II code that represents:
AlloDerm, per square centimeter
AlloDerm is an acellular dermal matrix derived from donated human skin. It acts as a skin substitute, providing a scaffold that supports tissue regeneration and healing.
This code reports the product itself, not the surgical application or procedure.
What Is AlloDerm Used For?
AlloDerm is commonly used in:
- Chronic wound management
- Burn treatment
- Surgical reconstruction
- Hernia repair
- Breast reconstruction
- Soft tissue defects
Because it integrates with the patient’s tissue, it is widely used in both inpatient and outpatient settings.
Key Details of Q4116
- Code Type: HCPCS Level II
- Product: AlloDerm
- Billing Unit: Per square centimeter
- Category: Skin substitute / biologic implant
- Purpose: Reports the cost of the AlloDerm product
How to Bill HCPCS Code Q4116
Q4116 is billed based on the total surface area used, measured in square centimeters (cm²).
Example:
-
If 40 cm² of AlloDerm is applied, bill 40 units of Q4116
This code must be billed in addition to the appropriate CPT application or surgical procedure code, which describes how the product was applied.
CPT Codes Commonly Billed With Q4116
Q4116 is often billed with CPT codes related to:
- Skin substitute application
- Surgical wound repair
- Burn or ulcer treatment
- Tissue grafting procedures
The CPT code reflects the procedure, while Q4116 reflects the biologic material used.
Documentation Requirements
To support billing Q4116, documentation should clearly include:
- Medical necessity for using a skin substitute
- Wound type, size, and location
- Exact surface area treated (in cm²)
- Product name (AlloDerm)
- Date of service
- Provider signature
Accurate measurement and clear documentation are critical to avoid denials.
Common Billing Mistakes to Avoid
- Incorrect unit calculation
- Billing Q4116 without a related procedure code
- Missing wound measurements
- Using the code for non-covered indications
- Incomplete medical necessity documentation
Coverage and Reimbursement Considerations
Coverage for Q4116 varies by:
- Insurance payer
- Wound type
- Clinical indication
- Frequency of application
Many payers require:
- Prior authorization
- Failure of conservative treatment
- Specific diagnosis codes
Always verify payer-specific policies before billing.
Why Q4116 Matters in Medical Billing
AlloDerm is a high-cost biologic product, and Q4116 ensures providers are reimbursed for its use. Proper coding supports compliance, reduces claim rejections, and reflects the true cost of advanced wound care and reconstructive procedures.
Frequently Asked Questions About Q4116
Is Q4116 a CPT code?
No, it is an HCPCS Level II code.
Does Q4116 include application of AlloDerm?
No, it only covers the product. Application is billed separately.
Can Q4116 be billed multiple times?
Yes, units are based on total square centimeters used.
Is AlloDerm considered a skin graft?
It is a skin substitute, not a traditional autograft.
Conclusion
HCPCS code Q4116 is used to bill AlloDerm per square centimeter when applied as a skin substitute in wound care and surgical procedures. Accurate unit calculation, proper documentation, and pairing with the correct CPT procedure code are essential for clean claims and appropriate reimbursement.
Understanding how and when to use Q4116 helps providers stay compliant while ensuring fair payment for advanced biologic materials used in patient care.