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HCPCS Q4107: GraftJacketMedicare rate & RVUs

Report Q4107 for GraftJacket acellular dermal matrix used with a qualifying graft-application procedure, based on the product amount applied.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $127.26 for Q4107 nationally in the office. Local office rates run $109.31–$183.51.

Medicare rate · Q4107

GraftJacket

Work RVUs
0
Total RVUs
3.81
Global days
ZZZ

National rate · 2026

$127.26

Office setting, before claim adjustments.

See every locality for Q4107 →Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What Q4107 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 payment localities

$109.31 to $183.51

$109.31$146.41$183.51
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

Q4107 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$111.35Unavailable
Alaska*$135.53Unavailable
Arizona$123.31Unavailable
Arkansas$109.31Unavailable
Atlanta$129.29Unavailable
Austin$134.64Unavailable
Bakersfield$139.47Unavailable
Baltimore/Surr. Cntys$136.55Unavailable
Beaumont$115.80Unavailable
Brazoria$126.11Unavailable

Q4107 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
Q4107 office rate range by state
State / territoryOffice rate rangeLocalities
AK$135.531
AL$111.351
AR$109.311
AZ$123.311
CA$139.47–$183.5129
CO$135.401
CT$137.061
DC$149.911
DE$125.731
FL$121.66–$132.473
GA$113.51–$129.292
GU$144.691
HI$144.691
IA$116.441
ID$117.081
IL$116.19–$130.694
IN$117.971
KS$115.041
KY$113.131
LA$112.62–$119.752
MA$134.00–$151.952
MD$128.78–$149.913
ME$117.08–$126.112
MI$116.19–$122.802
MN$130.951
MO$109.70–$121.153
MS$109.571
MT$127.261
NC$118.731
ND$127.261
NE$117.461
NH$132.471
NJ$138.97–$147.622
NM$116.701
NV$127.381
NY$120.89–$151.315
OH$116.191
OK$113.641
OR$126.75–$141.382
PA$116.82–$132.472
PR$128.661
RI$131.461
SC$117.591
SD$127.261
TN$115.681
TX$115.80–$134.648
UT$119.621
VA$125.09–$149.912
VI$128.661
VT$125.981
WA$134.00–$156.142
WI$121.911
WV$110.591
WY$127.261

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical3Technical component only.

Q4107 compared with similar codes

Compare codes · National

4 codes, side by side

  • Q4107

    GraftJacket0 wRVU

    $127.26

  • Q4113

    Not on the physician fee schedule0 wRVU

    Not priced

  • Q4112

    Not on the physician fee schedule0 wRVU

    Not priced

  • Q4105

    Skin substitute0 wRVU

    $127.26+$0.00

How to choose

Q4113Graftjacket xpress
Q4113 identifies GraftJacket Xpress. Use Q4107 for GraftJacket, and match the code to the product actually applied.
Q4112Cymetra injectable
Q4112 is for injectable Cymetra. Q4107 identifies GraftJacket matrix material rather than the injectable product.
Q4105Skin substitute
Q4105 identifies Integra DRT or Omnigraft, not GraftJacket. Choose according to the specific graft product used.

Codes related to Q4107

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to Q4107
CodeHow it relatesNational office range
Primary code
15271Skin substitute graftPrimary application procedure for qualifying trunk, arm, or leg sites within its defined area.$140.17–$205.27
Used instead
Q4113Graftjacket xpressIdentifies GraftJacket Xpress rather than the GraftJacket product reported with Q4107.No office rate
Q4112Cymetra injectableIdentifies injectable Cymetra, a different form of acellular dermal material.No office rate
Q4105Skin substituteIdentifies Integra DRT or Omnigraft, a different graft product.$109.31–$183.51
Q4122Wound matrixIdentifies Dermacell AWM, a different wound matrix product.$109.31–$183.51

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
RVUs for Q4107PPRRVU2026_Oct_nonQPP.csv, line 18,206 (RVU26D)

Open CMS sourceHow we calculate rates

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