WoundReference logo

XWRAP Plus

XWRAP Plus

XWRAP Plus

Technology and Product Assessment
Product Type: Human Skin Allografts
Other related products
Unbiased information for educational purposes only. WoundReference does not produce, market, advertise, re-sell or distribute healthcare goods or services consumed by, or used on patients. For information about specific products, please contact the manufacturer directly.

XWRAP Plus® is a single layer, chorion-free amniotic membrane allograft.

INTENDED USES: XWRAP Plus® is intended for homologous use as a wound barrier or cover applied to partial and full thickness acute and chronic wounds such as diabetic, venous, arterial, pressure and other ulcers, including those with exposed tendon, muscle, bone, or other vital structures, as well as traumatic and complex wounds, burns, surgical and Mohs surgery sites. 

CLAIMED BENEFITS: XWRAP Plus® is supplied in various size and configuration sheets.

OPTIONS: Available sizes

XWP-70202 - 2x2cm, each: Q4357

XWP-70204 - 2x4cm, each: Q4357

XWP-70206 - 2x6cm, each: Q4357

XWP-70404 - 4x4cm, each: Q4357

XWP-70406 - 4x6cm, each: Q4357

XWP-70408 - 4x8cm, each: Q4357

Manufacturer: Applied Biologics, LLC
Information retrieved from manufacturer and/or FDA-approved labels
* Wound Reference does not produce, market, re-sell or distribute health care goods or services consumed by, or used on, patients. The product information contained on this page, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers. Every effort has been made to ensure the accuracy of the product information, however on occasion manufacturers may alter their products or packaging without notice. Wound Reference assumes no liability for inaccuracies or misstatements about products. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Due to product changes, information listed in this document is subject to change without notice. We recommend that you always read labels, warnings and instructions for use before using a product. Content on this site is for reference purposes and is not intended to be a substitute for professional advice given by a physician or other licensed healthcare professional.

ESSENTIALS

Product
Estimated
Out-of-pocket
Cost
HCPCS Class
HCPCS
XWRAP Plus, per square centimeter
XWRAP Plus, per square centimeter
Xwrap plus, per square centimeter
Q4357
* Hover on the information button next to each header for detailed explanation on the type of information provided by the table
Select your state for Medicare
DME coverage and co-payment
Product
Estimated
Out-of-pocket
Cost
Patient DME Co-Payment per Billable Unit
DME Reimbursement to Suppliers
Frequency Replacement if Requirements Met
Office and/or Facility - Product reimbursement
XWRAP Plus, per square centimeter
Applied Biologics, LLC
XWRAP Plus, per square centimeter
$.00
Coming soon
* Every effort has been made to ensure the accuracy of the product information, however you should visit the manufacturer's website for the latest information.
* Hover on the information button next to each header for detailed explanation on the type of information provided by the table
Product
Estimated
Out-of-pocket
Cost
Recom / Evidence
FDA Safety
Quality Measures
Cost Effectiveness
XWRAP Plus, per square centimeter
XWRAP Plus, per square centimeter
361 HCT/P
Coming soon
Coming soon
Product
Estimated
Out-of-pocket
Cost
Features
XWRAP Plus, per square centimeter
XWRAP Plus, per square centimeter
No CPT codes to display.
  • Hover on the information button next to each header for detailed explanation on the type of information provided by the table
  • The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.
  • CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2018, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced on Wound Reference are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the American Medical Association prior to the submission of claims for reimbursement of covered services.
* Scroll table to see all products.

CLINICAL

FDA

Regulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products.

CODING, COVERAGE AND REIMBURSEMENT

This section currently focuses primarily on Medicare. It may be expanded in the future to include information on private insurers as well.  


Frequency of replacement allowed by Medicare



Medicare Administrative Contractor (MAC)Frequency of replacement if requirements met

Novitas Solutions, Inc.

CGS Administrators, LLC

First Coast Service Options, Inc. (FCSO)

Palmetto

Noridian

Wisconsin Physicians Service Insurance Corporation (WPS)

National Government Services, Inc. (NGS)

Carrier discretion


More details on requirements, medical necessity and documentation in specific Medicare Local Coverage Determinations (if available). See section on Coding, Coverage and Reimbursement in topic "Cellular and/or Tissue Products". 

Official reprint from WoundReference® woundreference.com ©2026 Wound Reference, Inc. All Rights Reserved
Use of WoundReference is subject to the Subscription and License Agreement. ​
NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
Topic 3265 Version 1.0

RELATED TOPICS

GammaGraft

CLINICALIndicationsVenous Stasis UlcersDiabetic Foot UlcersFull Thickness UlcersMohs Surgery SitesSkin Graft Donor SitesAreas of DermabrasionPartial Thickness BurnsPartial Thickness WoundsTemporary Coverage for Exposed Abdominal Viscera including Small Bowel and LiverExposed Peric

TheraSkin®

CLINICALIndicationsFor homologous use in diabetic foot ulcers, venous stasis ulcers, and pressure ulcers. FDARegulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products. Creates a unified registration and listing system for establishments that manufacture HCT/Ps and establishes donor eligibility, current good tissue practice, and other procedures to prevent the introduction, transmission, and spread of commun

DermaPure® Decellularized Dermal Allograft

CLINICALIndicationsDermaPure® Decellularized Dermal Allogra provides a scaffold for the body’s repair or replacement of damaged or inadequate integumental tissue or for other homologous uses of human integument. FDARegulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products. Creates a unified registration and listing sys

MemoDerm™ Acellular Dermal Matrix

CLINICALIndicationsFor homologous use in: Rotator Cuff, Anterior Shoulder Capsule, Flex/Extensor Tendon, Ulnar Collateral Ligament, Achilles Tendon, Lateral Ankle Complex, Chronic Diabetic Foot Ulcer. FDARegulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products. Creates a unified registration and listing system for est

Matrix HD

CLINICALIndicationsMatrix HD is a sterile acellular human dermis designed for reconstructive surgery and for treating chronic skin wounds FDARegulated under PHS 361 [21 CFR 1270 & 1271]: Human cells, tissues, and cellular and tissue-based products. Creates a unified registration and listing system for establishments that manufacture HCT/Ps and establishes donor eligibility, current good tissue practice, and other procedures to prevent the introduction, tr

6/20/2026 8:25:48 PM
WoundReference logo
San Francisco, CA
p:(650) 539-9883
e:support@woundreference.com
@:https://woundreference.com
Schedule Meeting
©2026 Wound Reference Inc.

Basic Navigation

Welcome
Features
Partners & Awards
Pricing Plans
About Us
Contact Us
Blog
Security
Privacy
Terms

Feature Navigation

Member Home
Wound Care
Hyperbaric (HBO)
CME/CE Credits
Product Navigator
Specialist Finder

Solutions

Individuals:
Wound Care Professional
Hyperbaric Medicine Professional
Biller & Coder
Institutions:
Wound Care Clinic
Mobile Wound Care Programs
Hyperbaric Oxygen Therapy Programs
Home Health Groups
Special Features:
Telemedicine & Telehealth
Hyperbaric and Wound Care Competency
t
-->