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HCPCS Q4289: Wound productMedicare rate & RVUs

Reports the square-centimeter quantity of Revoshield+ amniotic wound material used with a primary skin-substitute application procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities10.3K Medicare services in 2024

Medicare pays $127.26 for Q4289 nationally in the office. Local office rates run $109.31–$183.51.

Medicare rate · Q4289

Wound product

Work RVUs
0
Total RVUs
3.81
Global days
ZZZ

National rate · 2026

$127.26

Office setting, before claim adjustments.

See every locality for Q4289 →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 Q4289 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 Q4289 covers

Q4289 identifies the Revoshield+ amniotic product supplied for wound coverage, measured in square centimeters. It is generally reported by clinicians applying an amniotic membrane product during outpatient wound care, such as treatment of a chronic lower-extremity ulcer. The product line is distinct from the clinical work of preparing and treating the wound.

Report the quantity in square centimeters and pair Q4289 with the primary application procedure selected for the wound site and treated area; it is not a standalone application service. CMS treats it as an add-on paid within the primary procedure’s global period. CMS also classifies it as technical-component-only, with interpretation covered by a separate code. Documentation should identify Revoshield+, the wound location, product quantity, and corresponding application procedure.

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 Q4289 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

Q4289 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

Q4289 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
Q4289 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 Q4289 rate is calculated

Each of Q4289’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 · Q4289

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 Q4289

The CMS indicators that decide how Q4289 is paid alongside other services.

CMS payment indicators · Q4289

Wound product

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.

Q4289 compared with similar codes

Compare codes · National

5 codes, side by side

  • Q4289

    Wound product0 wRVU

    $127.26

  • 15271

    Skin substitute graft1.46 wRVU

    $157.99+$30.73

  • 15275

    Skin substitute1.78 wRVU

    $160.32+$33.06

  • Q4280

    Amniotic matrix0 wRVU

    $127.26+$0.00

  • Q4294

    Amniotic graft0 wRVU

    $127.26+$0.00

How to choose

15271Skin substitute graft
15271 reports the application service for its specified body sites; Q4289 reports the Revoshield+ product quantity used with a primary application procedure.
15275Skin substitute
15275 represents application work for a different group of body sites. Q4289 identifies the Revoshield+ product, not the application service.
Q4280Amniotic matrix
Q4280 identifies Xcell amnio matrix, while Q4289 identifies Revoshield+. Select the product code that matches the material used.
Q4294Amniotic graft
Q4294 identifies amnio quad-core rather than Revoshield+. These product-specific codes are not interchangeable based solely on the wound site.

Codes related to Q4289

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

Codes related to Q4289
CodeHow it relatesNational office range
Primary code
15271Skin substitute graftPrimary skin-substitute application procedure for specified trunk, arm, and leg sites.$140.17–$205.27
15275Skin substitutePrimary skin-substitute application procedure for specified head, neck, hand, foot, and genital sites.$143.80–$205.40
Used instead
Q4280Amniotic matrixXcell amnio matrix is a different amniotic product code measured per square centimeter.$109.31–$183.51
Q4294Amniotic graftAmnio quad-core is a separate amniotic product code measured per square centimeter.$109.31–$183.51
Q4295Amniotic tissue productAmnio tri-core is a separate amniotic product code measured per square centimeter.$109.31–$183.51

Q4289 billing questions

Can Q4289 be billed by itself?

No. CMS identifies it as an add-on code, so report it with the applicable primary procedure rather than as a standalone service.

Which application procedure should accompany Q4289?

Choose the primary skin-substitute application procedure according to the treated body site and wound area. For example, 15271 and 15275 address different site groups.

How should the units be determined?

The code is measured per square centimeter. Document the product quantity associated with the application and the wound measurements supporting treatment.

Does Q4289 include the clinician’s wound application work?

Q4289 represents the Revoshield+ product quantity. Report the primary application procedure separately to represent the application service.

How does the technical-component rule affect reporting?

CMS classifies Q4289 as technical-component-only; a separate code covers interpretation.

What documentation supports Q4289?

Record the Revoshield+ product, the treated wound location, the square-centimeter quantity, and the primary application procedure.

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 Q4289PPRRVU2026_Oct_nonQPP.csv, line 18,376 (RVU26D)

Open CMS sourceHow we calculate rates

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