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HCPCS Q4426: Skin substituteMedicare rate & RVUs

Reports DermBnd TL+ or TLX skin substitute by square centimeter when the product is supplied for application to a wound with a primary procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $127.26 for Q4426 nationally in the office. Local office rates run $109.31–$183.51.

Medicare rate · Q4426

Skin substitute

Swap in your local Medicare rate.

Work RVUs
0
Total RVUs
3.81
Global days
ZZZ

National rate · 2026

$127.26

Office setting, before claim adjustments.

See every locality for Q4426 → · 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 Q4426 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 Q4426 covers

Q4426 identifies the DermBnd TL+ or TLX skin substitute product in square-centimeter units. It represents the product supplied for wound coverage, not the clinician’s work applying it. The product may be used in wound care settings where a clinician applies a skin substitute to a wound; the application itself is reported separately with the procedure code selected for the wound’s site and treated area.

Report Q4426 only with a primary procedure, and count the product area in square centimeters as supported by the record. Documentation should identify the product, the wound treated, and the quantity used. CMS treats this as an add-on code paid within the primary procedure’s global period. It is classified as technical-component-only; a separate code covers interpretation. The product code does not replace the application procedure code, and the two code selections serve different purposes.

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 Q4426 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

Q4426 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

Q4426 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
Q4426 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 Q4426 rate is calculated

Each of Q4426’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 · Q4426

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 0.00Practice expense 3.81Malpractice 0.00

3.8100 adjusted RVUs×$33.4009 conversion factor=$127.26

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for Q4426

The CMS indicators that decide how Q4426 is paid alongside other services.

CMS payment indicators · Q4426

Skin substitute

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.

Q4426 compared with similar codes

Compare codes

Q4426 vs Q4427 vs Q4428 vs 15271: national Medicare rates

Swap in your local Medicare rate.

  • Q4426
    Skin substitute · 0 wRVU
    $127.26
  • Q4427
    Skin substitute · 0 wRVU
    $127.26+$0.00
  • Q4428
    DermBnd skin substitute · 0 wRVU
    $127.26+$0.00
  • 15271
    Skin substitute graft · 1.46 wRVU
    $157.99+$30.73

How to choose

Q4427Skin substitute
Q4427 identifies a different DermBnd product designation. Use the code matching the product supplied, not simply another DermBnd code.
Q4428DermBnd skin substitute
Q4428 represents a different DermBnd product designation from TL+ or TLX. Match the product code to the product documented.
15271Skin substitute graft
15271 reports the application procedure for qualifying wounds on the trunk or extremities; Q4426 reports the DermBnd product by square centimeter.

Codes related to Q4426

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

Codes related to Q4426
CodeHow it relatesNational office range
Primary code
15271Skin substitute graftPrimary skin-substitute application procedure for qualifying wounds on the trunk or extremities.$140.17–$205.27
15273Skin substitute graftPrimary skin-substitute application procedure for qualifying wounds on the scalp, face, or neck.$285.52–$407.73
Same family
Q4427Skin substituteDermBnd product code with a different product designation.$109.31–$183.51
Q4428DermBnd skin substituteAnother DermBnd product designation billed by square centimeter.$109.31–$183.51
Q4429DermBnd skin substituteAnother DermBnd product designation billed by square centimeter.$109.31–$183.51

Q4426 billing questions

Is Q4426 the wound application procedure?

No. Q4426 reports the DermBnd TL+ or TLX product by square centimeter. Report the appropriate wound application procedure separately as the primary service.

Can Q4426 be billed by itself?

No. CMS identifies Q4426 as an add-on code that must be billed with a primary procedure.

How should the units be determined?

Use the documented square centimeters of DermBnd TL+ or TLX product supplied for the wound. The record should support the product and quantity reported.

Which code should be used for the application?

Select the primary skin-substitute application code based on the wound’s site and treated area. Q4426 identifies the product, not the application work.

How does the global-period rule affect Q4426?

CMS pays this add-on within the global period of its primary procedure. Report it with that procedure rather than as a stand-alone service.

Does Q4426 include interpretation?

No. CMS classifies Q4426 as technical-component-only, with a separate code covering 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
RVUs for Q4426PPRRVU2026_Oct_nonQPP.csv, line 18,511 (RVU26D)

Open CMS sourceHow we calculate rates

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