HCPCS Q4197: PuraPly XTMedicare rate & RVUs

Medicare pays $127.26 for Q4197 nationally in the office. Local office rates run $109.31–$183.51.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What Q4197 covers

PuraPly XT is a wound matrix placed over a prepared wound to provide a protective covering. Q4197 identifies the specific product rather than the clinician’s work of applying it. Wound-care clinicians may use the matrix during treatment of a difficult-to-heal wound, such as a lower-leg ulcer, in an office or facility setting. The application procedure is identified separately according to the wound site and the procedure performed.

Report Q4197 in square-centimeter units for PuraPly XT, supported by the product record and the amount used. Confirm the product name: standard PuraPly and PuraPly AM have different codes. CMS designates Q4197 as an add-on code, so it is billed only with a primary procedure and is paid within that procedure’s global period. CMS also classifies it as technical-component-only; a separate code covers interpretation. Q4197 therefore represents the product component, not the professional work of applying the matrix or an interpretation service.

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 Q4197 pays more and less

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

109 of 109 payment localities

Q4197 rates by state

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

How the Q4197 rate is calculated

Each of Q4197’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.

Payment rules and modifiers for Q4197

The CMS indicators that decide how Q4197 is paid alongside other services.

Q4197 compared with similar codes

How to choose

Q4195Wound matrix

Use Q4195 when the documented product is PuraPly. Use Q4197 only when it is PuraPly XT.

Q4196Wound matrix

Use Q4196 for PuraPly AM. The AM and XT product names identify different matrix codes.

15271Skin substitute graft

Q4197 identifies the PuraPly XT matrix by square centimeter; 15271 describes application to a qualifying wound on the trunk, arms, or legs. They represent different parts of the encounter.

Codes related to Q4197

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

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

Open CMS sourceHow we calculate rates