HCPCS Q4173
PalinGen® Membrane
Bioengineered skin substitute for non-healing wounds
A human tissue allograft derived from amniotic membrane — chorion-free, bioactive, and available dry or wet — for chronic wounds that have failed to respond to standard of care.
Amniotic Allograft
Chorion-Free Protection Meets Bioactive Coverage
PalinGen® Membrane pairs a chorion-free amniotic barrier with proprietary processing that preserves ECM, growth factors, and cytokines.
Chorion-Free
Reduced antigen risk
Does not contain chorion, further reducing the risk of an adverse immune reaction.
Bioactive
ECM & growth factors
Proprietary processing preserves extracellular matrix, growth factors, and cytokines.
Dry & Wet
Hydromembrane options
Available in wet (Hydromembrane) and dry forms across a variety of sizes.
Q4173
HCPCS code
Assigned HCPCS skin substitute code for claims submission (informational only).
Why Amniotic Membrane
Amniotic membrane is an attractive protective covering and a rich source of biologically active factors that play an important role in wound healing and tissue regeneration.
Chorion-Free
The chorion layer of the amniotic membrane has been known to contain maternal antigens. PalinGen® Membrane does not contain chorion, further reducing the risk of an adverse reaction.
Bioactive Processing
Processed using a proprietary technique that does not alter the original relevant biological characteristics of the tissue, including ECM, growth factors, and cytokines.
Dry & Wet Options
Air-dried and attached to white polymesh on the fetal side, or available wet (Hydromembrane). The allograft can be placed over the wound and naturally adheres; fixation at clinician’s discretion.
Clinical Use
For wounds failing to respond to standard wound care treatments.
Available Sizes
Ten sizes across dry and wet (Hydromembrane) options to match common wound dimensions.
Ordering codes available on request — contact us. Available in dry and wet (Hydromembrane) options.
| Size | Coverage Area |
|---|---|
| 1 × 1 cm | 1 cm² |
| 1 × 2 cm | 2 cm² |
| 2 × 2 cm | 4 cm² |
| 2 × 3 cm | 6 cm² |
| 2 × 4 cm | 8 cm² |
| 2 × 6 cm | 12 cm² |
| 4 × 4 cm | 16 cm² |
| 4 × 6 cm | 24 cm² |
| 4 × 8 cm | 32 cm² |
| 8 × 8 cm | 64 cm² |
Safety & Recovery
Donated human amniotic tissue is recovered after live cesarean birth with maternal consent, using stringent screening protocols and aseptic processing.
Recovery Standards
- Recovered after live cesarean birth with maternal consent — does not involve fetal harm
- Safe recovery techniques and sterile equipment to minimize bioburden
- Stringent screening and recovery protocols in a highly controlled environment
- Tissues processed aseptically under FDA HCT/P regulations
- Donors prescreened via intensive medical review and pre-natal evaluation
Donor Screening Panel
Donor blood tested prior to or at time of recovery:
References & Coding
Supported by published literature on amniotic membrane allografts in chronic wound care.
A Retrospective Crossover Study of the Use of Aseptically Processed Placental Membrane in the Treatment of Chronic Diabetic Foot Ulcers
Didomenico LA, Orgill DP, Galiano RD, Serena TE, Carter MJ, Kaufman JP, Young NJ, Zelen CM (2017)
Wounds. 2017 Jul 26.
The Use of Human Amnion/Chorion Membrane in the Clinical Setting for Lower Extremity Repair
Zelen CM, Snyder RJ, Serena TE, Li WW (2015)
Clin Podiatr Med Surg. 2015 Jan;32(1):135-46.
The Use of Dehydrated Human Amnion/Chorion Membranes in the Treatment of Burns and Complex Wounds
Tenenhaus M (2017)
Ann Plast Surg. 2017 Feb;78(2 Suppl 1):S11-S13.
An evaluation of dehydrated human amniotic membrane allografts in patients with DFUs
Zelen CM (2013)
J Wound Care. 2013 Jul;22(7):347-351.
Amniotic membrane can be a valid source for wound healing
ElHeneidy H, Omran E, Halwagy A, Al-Inany H, Al-Ansary M, Gad A (2016)
Int J Womens Health. 2016 Jun;8:225-31.
HCPCS code Q4173 is supplied for informational purposes only. It does not constitute a promise or guarantee of coverage or payment. Coding practices vary by payer, diagnosis, site of care, and other factors. The provider is responsible for verifying coverage with applicable payers.
Advance Healing with Chorion-Free Coverage
Partner with DermaLynx to bring PalinGen® Membrane and our complete portfolio of advanced wound care solutions to your practice.