Q4395: Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure)
Q4395 is a HCPCS Level II code for acelagraft, per square centimeter (add-on, list separately in addition to primary procedure). It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 0.00
- PE (non-facility)
- 3.81
- PE (facility)
- 3.81
- Malpractice RVU
- 0.00
Global period: ZZZ
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for Q4395
- Long descriptor
- Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Short descriptor
- Acelagraft per sq cm
- Added
- October 1, 2025
- BETOS
- O1E
- Pricing indicator
- 11: Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service: CMS's own analytic grouping.
Price established using national RVUs.
Codes adjacent to Q4395
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If Q4395 is not quite right, the correct code is very often within a few positions of it.
- Q4387Neothelium ft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4388Neothelium 4l, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4389Neothelium 4l+, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4390Ascendion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4391Amnioplast double, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4392Grafix duo, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4393Surgraft ac, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4394Surgraft aca, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4396Natalin, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4397Summit aaa, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4398Summit ac, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4399Summit fx, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4400Polygon3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4401Absolv3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4402Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4403Xwrap dual plus, per square centimeter (add-on, list separately in addition to primary procedure)