HCPCS code Q4105: Skin substitute, integra DRT or Omnigraft2026 Medicare rate & RVUs in California
Reports Integra DRT or Omnigraft wound matrix supplied for application to a wound, such as a burn or diabetic foot ulcer.
Medicare pays $139.47–$183.51 for Q4105 in the office in California, from Bakersfield, CA to Santa Clara County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What Q4105 covers
Q4105 identifies the Integra dermal regeneration template product, including Omnigraft, supplied for wound coverage. The material is used in wound care, including burn treatment and, for Omnigraft, diabetic foot ulcer treatment. Plastic surgeons, wound-care clinicians, and podiatrists may use it in hospital outpatient departments, clinics, or other settings where a wound application procedure is performed. The product supply is distinct from the clinician’s work applying it.
Report Q4105 with the primary procedure used to apply the product, selecting that procedure for the wound’s site and treated area. Document the exact product, wound location and dimensions, amount supplied and applied, and the related application procedure. CMS classifies Q4105 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period. CMS also classifies it as technical-component-only, with interpretation covered by a separate code.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where Q4105 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$139.47 to $183.51
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $139.47 | Unavailable |
| Chico, CA | $139.47 | Unavailable |
| El Centro, CA | $139.47 | Unavailable |
| Fresno, CA | $139.47 | Unavailable |
| Hanford, CA | $139.47 | Unavailable |
| Los Angeles, CA | $150.55 | Unavailable |
| Madera, CA | $139.47 | Unavailable |
| Marin County, CA | $179.43 | Unavailable |
| Merced, CA | $139.47 | Unavailable |
| Modesto, CA | $139.47 | Unavailable |
| Napa, CA | $167.73 | Unavailable |
| Oxnard, CA | $150.42 | Unavailable |
| Redding, CA | $139.47 | Unavailable |
| Rest of California | $139.47 | Unavailable |
| Riverside, CA | $139.47 | Unavailable |
| Sacramento, CA | $148.00 | Unavailable |
| Salinas, CA | $147.49 | Unavailable |
| San Benito County, CA | $183.51 | Unavailable |
| San Diego, CA | $152.20 | Unavailable |
| San Francisco, CA | $179.43 | Unavailable |
| San Luis Obispo, CA | $144.95 | Unavailable |
| Santa Clara County, CA | $183.51 | Unavailable |
| Santa Cruz, CA | $154.62 | Unavailable |
| Santa Maria, CA | $148.38 | Unavailable |
| Santa Rosa, CA | $156.27 | Unavailable |
| Stockton, CA | $139.47 | Unavailable |
| Vallejo, CA | $167.73 | Unavailable |
| Visalia, CA | $139.47 | Unavailable |
| Yuba City, CA | $139.47 | Unavailable |
How the Q4105 rate is calculated
Each of Q4105’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · Q4105
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense3.81
3.81 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
3.8100
Conversion factor
$33.4009
Medicare rate
$127.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for Q4105
The CMS indicators that decide how Q4105 is paid alongside other services.
CMS payment indicators · Q4105
Skin substitute, integra DRT or Omnigraft
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
Q4105 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4104Wound matrixIntegra BMWD
- Q4104 identifies Integra BMWD, not Integra DRT or Omnigraft. Report the code that matches the product supplied.
- Q4108Wound matrixIntegra Matrix
- Q4108 identifies Integra Matrix. Q4105 is specific to Integra DRT or Omnigraft.
- Q4101Skin substituteApligraf, per square centimeter
- Q4101 identifies Apligraf, a different product. Use Q4105 only when the supplied product is Integra DRT or Omnigraft.
Q4105 billing questions
How is Q4105 different from the Integra product codes Q4104 and Q4108?
Q4105 identifies Integra DRT or Omnigraft. Q4104 and Q4108 identify different Integra products, so verify the product actually supplied rather than choosing by manufacturer alone.
Can Q4105 be billed by itself?
No. CMS identifies it as an add-on code, so report it with the primary procedure used to apply the product.
Which application code should accompany Q4105?
Choose the primary wound-application procedure according to the wound site and treated area. For example, the application-code family includes 15271 for trunk, arm, or leg sites and 15275 for sites such as the feet.
What should the record support?
Document the exact Integra product, wound site and dimensions, amount supplied and applied, and the application procedure. The documentation should make clear that Q4105 represents the product rather than the application work.
How does the global-period rule affect Q4105?
Q4105 is billed with its primary procedure and paid within that procedure’s global period. It is not a stand-alone service line.
Does Q4105 include interpretation?
CMS classifies Q4105 as technical-component-only and assigns interpretation to a separate code. Q4105 itself identifies the product supply.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
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