HCPCS code Q4235: Wound tissue product, amniorepair or Altiply2026 Medicare rate & RVUs in Hawaii, Guam, HI
Reports Amniorepair or Altiply wound-coverage product by square centimeter when supplied with a primary wound application procedure.
In Hawaii, Guam, HI, Medicare pays $144.69 for Q4235 in the office.
Check a contract rate as a % of Medicare · Q4235 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What Q4235 covers
Q4235 identifies Amniorepair or Altiply wound-coverage product supplied by square centimeter; it represents the product, not the work of placing it. These products may be used as biologic coverings during treatment of open wounds, including chronic ulcers. A wound-care physician, surgeon, or other qualified practitioner may apply the product to a prepared wound bed in an office or hospital outpatient setting as part of a wound procedure. The associated application service is reported separately.
Report Q4235 only with a qualifying primary application procedure. CMS classifies it as an add-on code and pays it within that procedure’s global period, so it is not a stand-alone service. Select the code based on the product supplied and report units on a per-square-centimeter basis. Documentation should identify the product, wound site, amount used, and primary procedure. CMS classifies Q4235 as technical-component-only; a separate code covers interpretation.
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.
How Hawaii, Guam, HI compares for Q4235
Across 109 of 109 payment localities, the office rate for Q4235 runs from $109.31 in Arkansas to $183.51 in Santa Clara County, CA. Hawaii, Guam, HI pays $144.69. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Hawaii, Guam, HI · this page$144.69
- Los Angeles, CA · California$150.55+$5.86
- Washington, DC area · District of Columbia$149.91+$5.22
- Miami, FL · Florida$132.47−$12.22
- Chicago, IL · Illinois$127.89−$16.80
- Manhattan, NY · New York$147.87+$3.18
- Alaska · Alaska$135.53−$9.16
Other areas in Hawaii first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $111.35 | — |
| ArkansasArkansas | $109.31 | — |
| ArizonaArizona | $123.31 | — |
| Bakersfield, CACalifornia | $139.47 | — |
| Chico, CACalifornia | $139.47 | — |
| El Centro, CACalifornia | $139.47 | — |
| Fresno, CACalifornia | $139.47 | — |
| Hanford, CACalifornia | $139.47 | — |
| Madera, CACalifornia | $139.47 | — |
| Merced, CACalifornia | $139.47 | — |
| Modesto, CACalifornia | $139.47 | — |
| Napa, CACalifornia | $167.73 | — |
| Oxnard, CACalifornia | $150.42 | — |
| Redding, CACalifornia | $139.47 | — |
| Rest of CaliforniaCalifornia | $139.47 | — |
| Riverside, CACalifornia | $139.47 | — |
| Sacramento, CACalifornia | $148.00 | — |
| Salinas, CACalifornia | $147.49 | — |
| San Diego, CACalifornia | $152.20 | — |
| Marin County, CACalifornia | $179.43 | — |
| San Francisco, CACalifornia | $179.43 | — |
| San Benito County, CACalifornia | $183.51 | — |
| Santa Clara County, CACalifornia | $183.51 | — |
| San Luis Obispo, CACalifornia | $144.95 | — |
| Santa Cruz, CACalifornia | $154.62 | — |
| Santa Maria, CACalifornia | $148.38 | — |
| Santa Rosa, CACalifornia | $156.27 | — |
| Stockton, CACalifornia | $139.47 | — |
| Vallejo, CACalifornia | $167.73 | — |
| Visalia, CACalifornia | $139.47 | — |
| Yuba City, CACalifornia | $139.47 | — |
| ColoradoColorado | $135.40 | — |
| ConnecticutConnecticut | $137.06 | — |
| DelawareDelaware | $125.73 | — |
| Fort Lauderdale, FLFlorida | $128.91 | — |
| Rest of FloridaFlorida | $121.66 | — |
| Atlanta, GAGeorgia | $129.29 | — |
| Rest of GeorgiaGeorgia | $113.51 | — |
| IowaIowa | $116.44 | — |
| IdahoIdaho | $117.08 | — |
| East St. Louis, ILIllinois | $117.08 | — |
| Rest of IllinoisIllinois | $116.19 | — |
| Suburban Chicago, ILIllinois | $130.69 | — |
| IndianaIndiana | $117.97 | — |
| KansasKansas | $115.04 | — |
| KentuckyKentucky | $113.13 | — |
| New Orleans, LALouisiana | $119.75 | — |
| Rest of LouisianaLouisiana | $112.62 | — |
| Metropolitan Boston, MAMassachusetts | $151.95 | — |
| Rest of MassachusettsMassachusetts | $134.00 | — |
| Baltimore area, MDMaryland | $136.55 | — |
| Rest of MarylandMaryland | $128.78 | — |
| Rest of MaineMaine | $117.08 | — |
| Southern Maine, MEMaine | $126.11 | — |
| Detroit, MIMichigan | $122.80 | — |
| Rest of MichiganMichigan | $116.19 | — |
| MinnesotaMinnesota | $130.95 | — |
| Metropolitan Kansas City, MOMissouri | $119.49 | — |
| Metropolitan St. Louis, MOMissouri | $121.15 | — |
| Rest of MissouriMissouri | $109.70 | — |
| MississippiMississippi | $109.57 | — |
| MontanaMontana | $127.26 | — |
| North CarolinaNorth Carolina | $118.73 | — |
| North DakotaNorth Dakota | $127.26 | — |
| NebraskaNebraska | $117.46 | — |
| New HampshireNew Hampshire | $132.47 | — |
| Northern New JerseyNew Jersey | $147.62 | — |
| Rest of New JerseyNew Jersey | $138.97 | — |
| New MexicoNew Mexico | $116.70 | — |
| NevadaNevada | $127.38 | — |
| NYC suburbs and Long Island, NYNew York | $151.31 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $139.35 | — |
| Queens, NYNew York | $150.42 | — |
| Rest of New YorkNew York | $120.89 | — |
| OhioOhio | $116.19 | — |
| OklahomaOklahoma | $113.64 | — |
| Portland, OROregon | $141.38 | — |
| Rest of OregonOregon | $126.75 | — |
| Metropolitan Philadelphia, PAPennsylvania | $132.47 | — |
| Rest of PennsylvaniaPennsylvania | $116.82 | — |
| Puerto RicoPuerto Rico | $128.66 | — |
| Rhode IslandRhode Island | $131.46 | — |
| South CarolinaSouth Carolina | $117.59 | — |
| South DakotaSouth Dakota | $127.26 | — |
| TennesseeTennessee | $115.68 | — |
| Austin, TXTexas | $134.64 | — |
| Beaumont, TXTexas | $115.80 | — |
| Brazoria, TXTexas | $126.11 | — |
| Dallas, TXTexas | $126.75 | — |
| Fort Worth, TXTexas | $125.48 | — |
| Galveston, TXTexas | $126.37 | — |
| Houston, TXTexas | $126.37 | — |
| Rest of TexasTexas | $120.77 | — |
| UtahUtah | $119.62 | — |
| VirginiaVirginia | $125.09 | — |
| Virgin Islands, VIUnited States Virgin Islands | $128.66 | — |
| VermontVermont | $125.98 | — |
| Rest of WashingtonWashington | $134.00 | — |
| King County, WAWashington | $156.14 | — |
| WisconsinWisconsin | $121.91 | — |
| West VirginiaWest Virginia | $110.59 | — |
| WyomingWyoming | $127.26 | — |
Q4235 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$109.31
$161.49
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $135.53 | 1 |
| AL | $111.35 | 1 |
| AR | $109.31 | 1 |
| AZ | $123.31 | 1 |
| CA | $139.47–$183.51 | 29 |
| CO | $135.40 | 1 |
| CT | $137.06 | 1 |
| DC | $149.91 | 1 |
| DE | $125.73 | 1 |
| FL | $121.66–$132.47 | 3 |
| GA | $113.51–$129.29 | 2 |
| GU | $144.69 | 1 |
| HI | $144.69 | 1 |
| IA | $116.44 | 1 |
| ID | $117.08 | 1 |
| IL | $116.19–$130.69 | 4 |
| IN | $117.97 | 1 |
| KS | $115.04 | 1 |
| KY | $113.13 | 1 |
| LA | $112.62–$119.75 | 2 |
| MA | $134.00–$151.95 | 2 |
| MD | $128.78–$149.91 | 3 |
| ME | $117.08–$126.11 | 2 |
| MI | $116.19–$122.80 | 2 |
| MN | $130.95 | 1 |
| MO | $109.70–$121.15 | 3 |
| MS | $109.57 | 1 |
| MT | $127.26 | 1 |
| NC | $118.73 | 1 |
| ND | $127.26 | 1 |
| NE | $117.46 | 1 |
| NH | $132.47 | 1 |
| NJ | $138.97–$147.62 | 2 |
| NM | $116.70 | 1 |
| NV | $127.38 | 1 |
| NY | $120.89–$151.31 | 5 |
| OH | $116.19 | 1 |
| OK | $113.64 | 1 |
| OR | $126.75–$141.38 | 2 |
| PA | $116.82–$132.47 | 2 |
| PR | $128.66 | 1 |
| RI | $131.46 | 1 |
| SC | $117.59 | 1 |
| SD | $127.26 | 1 |
| TN | $115.68 | 1 |
| TX | $115.80–$134.64 | 8 |
| UT | $119.62 | 1 |
| VA | $125.09–$149.91 | 2 |
| VI | $128.66 | 1 |
| VT | $125.98 | 1 |
| WA | $134.00–$156.14 | 2 |
| WI | $121.91 | 1 |
| WV | $110.59 | 1 |
| WY | $127.26 | 1 |
How the Q4235 rate is calculated
Each of Q4235’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 · Q4235
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.
The exact Hawaii, Guam, HI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
18,324
- Code
- Q4235
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
46
- Locality
- Hawaii, Guam, HI
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.81 | × 1.137 | 4.3320 |
| Malpractice | 0.00 | × 0.579 | 0.0000 |
| Total RVUs | 4.3320 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Hawaii, Guam, HI$144.69
Office: (0 × 1 + 3.81 × 1.137 + 0 × 0.579) × $33.4009 = $144.69
Payment rules and modifiers for Q4235
The CMS indicators that decide how Q4235 is paid alongside other services.
CMS payment indicators · Q4235
Wound tissue product, amniorepair or Altiply
| 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. |
How Q4235 has changed in Hawaii, Guam, HI
Q4235 · Office / nonfacility
$144.69
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
No ratechanged to$144.69
Held through RVU26B, RVU26C, RVU26D.
July 1, 2020
RVU20C
No ratechanged toNo rate
Held through RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $144.69 | Not available in this setting | RVU26D |
| 2026-07-01 | $144.69 | Not available in this setting | RVU26C |
| 2026-04-01 | $144.69 | Not available in this setting | RVU26B |
| 2026-01-01 | $144.69 | Not available in this setting | RVU26A |
| 2025-10-01 | Separate payment rules apply | Separate payment rules apply | RVU25D |
| 2025-07-01 | Separate payment rules apply | Separate payment rules apply | RVU25C |
| 2025-04-01 | Separate payment rules apply | Separate payment rules apply | RVU25B |
| 2025-01-01 | Separate payment rules apply | Separate payment rules apply | RVU25A |
| 2024-10-01 | Separate payment rules apply | Separate payment rules apply | RVU24D |
| 2024-07-01 | Separate payment rules apply | Separate payment rules apply | RVU24C |
| 2024-04-01 | Separate payment rules apply | Separate payment rules apply | RVU24B |
| 2024-03-09 | Separate payment rules apply | Separate payment rules apply | RVU24AR |
| 2024-01-01 | Separate payment rules apply | Separate payment rules apply | RVU24A |
| 2023-10-01 | Separate payment rules apply | Separate payment rules apply | RVU23D |
| 2023-07-01 | Separate payment rules apply | Separate payment rules apply | RVU23C |
| 2023-04-01 | Separate payment rules apply | Separate payment rules apply | RVU23B |
| 2023-01-01 | Separate payment rules apply | Separate payment rules apply | RVU23A |
| 2022-10-01 | Separate payment rules apply | Separate payment rules apply | RVU22D |
| 2022-07-01 | Separate payment rules apply | Separate payment rules apply | RVU22C |
| 2022-04-01 | Separate payment rules apply | Separate payment rules apply | RVU22B |
| 2022-01-01 | Separate payment rules apply | Separate payment rules apply | RVU22A |
| 2021-10-01 | Separate payment rules apply | Separate payment rules apply | RVU21D |
| 2021-07-01 | Separate payment rules apply | Separate payment rules apply | RVU21C |
| 2021-04-01 | Separate payment rules apply | Separate payment rules apply | RVU21B |
| 2021-01-01 | Separate payment rules apply | Separate payment rules apply | RVU21A |
| 2020-10-01 | Separate payment rules apply | Separate payment rules apply | RVU20D |
| 2020-07-01 | Separate payment rules apply | Separate payment rules apply | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Hawaii, Guam, HI rate applies
Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.
- Ahuimanu
- Aiea
- Ainaloa
- Anahola
- Black Sands
- Captain Cook
- Discovery Harbour
- East Honolulu
Q4235 billing questions
Does Q4235 describe applying the product?
No. It identifies the Amniorepair or Altiply product; report the wound application service separately as the primary procedure.
What determines whether Q4235 is the right product code?
Use Q4235 when the product supplied is Amniorepair or Altiply. Do not select it solely from wound location or type.
How are units reported?
The code is measured per square centimeter. Document the product amount used and the wound site.
Can Q4235 be billed without a primary procedure?
No. CMS identifies it as an add-on code that is billed with a primary procedure and paid within that procedure’s global period.
Does Q4235 include interpretation?
No. CMS classifies Q4235 as technical-component-only; a separate code covers interpretation.
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
Fee sheets · Coming soon
Put Q4235 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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