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HCPCS Q4146: Wound matrixMedicare rate & RVUs

Report TenSIX by square-centimeter unit when the product is furnished for wound coverage with a qualifying skin-substitute application procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $127.26 for Q4146 nationally in the office. Local office rates run $109.31–$183.51.

Medicare rate · Q4146

Wound matrix

Work RVUs
0
Total RVUs
3.81
Global days
ZZZ

National rate · 2026

$127.26

Office setting, before claim adjustments.

See every locality for Q4146 →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 Q4146 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 Q4146 covers

TenSIX is a biologic wound-covering product used in skin-substitute treatment of wounds, including chronic ulcers. A wound-care clinician, podiatrist, or surgeon may apply it after preparing the wound bed in an outpatient or surgical setting. The product code identifies the TenSIX material, not the work of preparing or applying the wound coverage.

Report one unit for each square centimeter of product furnished, alongside the primary skin-substitute application procedure appropriate to the treated site and area. The record should identify the product, wound location and dimensions, amount used, and application procedure. CMS treats Q4146 as an add-on: submit it only with a primary procedure, and its payment falls within that procedure's global period. It is technical-component-only; interpretation is represented separately.

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 Q4146 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

Q4146 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

Q4146 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
Q4146 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 Q4146 rate is calculated

Each of Q4146’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 · Q4146

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 Q4146

The CMS indicators that decide how Q4146 is paid alongside other services.

CMS payment indicators · Q4146

Wound matrix

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.

Q4146 compared with similar codes

Compare codes · National

Q4146 vs Q4145 vs Q4147: Medicare rates

  • Q4146

    Wound matrix0 wRVU

    $127.26

  • Q4145

    Not on the physician fee schedule0 wRVU

    Not priced

  • Q4147

    Wound matrix0 wRVU

    $127.26+$0.00

How to choose

Q4145Epifix, inj, 1mg
Q4145 identifies an injectable EpiFix product and uses a milligram unit; Q4146 identifies TenSIX by square-centimeter unit.
Q4147Wound matrix
Q4147 identifies Architect ECM PX FX by square-centimeter unit. Use Q4146 only when TenSIX is the product furnished.

Codes related to Q4146

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

Codes related to Q4146
CodeHow it relatesNational office range
Primary code
15271Skin substitute graftPrimary skin-substitute application procedure for eligible wounds and sites.$140.17–$205.27
15275Skin substitutePrimary skin-substitute application procedure for eligible wounds and sites.$143.80–$205.40
Often billed with
15272Skin substitute graftAdditional-area skin-substitute application procedure when the documented extent requires it.$23.02–$32.02

Q4146 billing questions

How is Q4146 different from Q4145?

Q4146 identifies TenSIX by square-centimeter unit. Q4145 identifies an injectable EpiFix product by milligram, so select the code for the product actually furnished.

What primary procedure should accompany Q4146?

Report it with the skin-substitute application procedure that fits the wound site and treated area, such as billing code 15271 or 15275 when applicable.

How many units should be reported?

Report one unit per square centimeter of TenSIX furnished. Document the wound dimensions and the amount of product used to support the units.

Is the application separately represented by Q4146?

No. Q4146 identifies the TenSIX product; report the appropriate primary procedure for the application. CMS treats Q4146 as an add-on paid within that procedure's global period.

Does Q4146 include interpretation?

No. CMS classifies Q4146 as technical-component-only, with interpretation covered by a separate code.

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 Q4146PPRRVU2026_Oct_nonQPP.csv, line 18,239 (RVU26D)

Open CMS sourceHow we calculate rates

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