HCPCS code Q4107: GraftJacket, per square centimeter2026 Medicare rate & RVUs in California
Report Q4107 for GraftJacket acellular dermal matrix used with a qualifying graft-application procedure, based on the product amount applied.
Medicare pays $139.47–$183.51 for Q4107 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 Q4107 covers
Q4107 identifies GraftJacket, an acellular dermal matrix used as a graft material in wound care and soft-tissue reconstruction. It may be used in treating chronic wounds, such as diabetic foot or venous leg ulcers, and in surgical reconstruction. The clinician applies the material to the prepared site; the product code represents the graft material, not the work of preparing the wound or applying the graft.
Report the product code with the appropriate primary procedure, selecting that procedure according to the treatment site and the extent of the application. Documentation should identify GraftJacket, the treated site, and the amount used; Q4107 is reported per square centimeter. CMS classifies this as an add-on code, so it is billed only with a primary procedure and paid within that procedure’s global period. It is a technical-component-only code, 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 Q4107 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 Q4107 rate is calculated
Each of Q4107’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 · Q4107
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 Q4107
The CMS indicators that decide how Q4107 is paid alongside other services.
CMS payment indicators · Q4107
GraftJacket, per square centimeter
| 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. |
Q4107 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4113GraftJacket XpressPer 1 cc
- Q4113 identifies GraftJacket Xpress. Use Q4107 for GraftJacket, and match the code to the product actually applied.
- Q4112Cymetra injectablePer 1 cc
- Q4112 is for injectable Cymetra. Q4107 identifies GraftJacket matrix material rather than the injectable product.
- Q4105Skin substituteIntegra DRT or Omnigraft
- Q4105 identifies Integra DRT or Omnigraft, not GraftJacket. Choose according to the specific graft product used.
Q4107 billing questions
Can Q4107 be reported by itself?
No. CMS identifies Q4107 as an add-on code, so it must be billed with a primary procedure.
Is Q4107 the wound application procedure?
No. Q4107 identifies the GraftJacket material. Report the appropriate application procedure separately as the primary procedure.
How should the quantity be documented?
Document the amount of GraftJacket used in square centimeters and the site where it was applied.
Does Q4107 include interpretation?
No. CMS classifies it as technical-component-only; a separate code covers interpretation.
How does Q4107 differ from Q4113?
Both identify GraftJacket products, but Q4113 is for GraftJacket Xpress. Select the code matching the specific product used.
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.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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