$144.69
Both are measured per square centimeter, but Q4395 is for Acelagraft. Use Q4396 when the documented product is Natalin.
On this page
CMS RVU26D · Effective 2026-10-01
Q4396 Natalin graft Medicare reimbursement rates in Hawaii
Report Q4396 for each square centimeter of Natalin used with a primary graft application procedure to treat a wound. Compare Q4396 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for Q4396 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$144.69
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Wound care
About Q4396: Natalin wound graft, per square centimeter
Report Q4396 for each square centimeter of Natalin used with a primary graft application procedure to treat a wound.
Q4396 identifies Natalin by product and measures the material in square centimeters. A wound care clinician, podiatrist, or surgeon may use it while treating a wound in an office or facility. The code describes the Natalin material rather than the work of preparing the wound and applying it. Select it only when the treatment record identifies Natalin; a different graft product calls for its own product code.
Report the number of square centimeters of Natalin used, supported by the wound measurements, product record, and amount documented for the application. Link Q4396 to the primary procedure performed at that encounter: CMS classifies it as an add-on code billed only with a primary procedure and paid within that procedure’s global period. CMS also classifies Q4396 as technical-component-only. A separate code covers interpretation when interpretation is performed and documented; Q4396 itself represents the technical portion.
CMS billing rules for Q4396
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Technical-component-only code: a separate code covers interpretation.
Where the value comes from
- Work RVU0.00 · 0%
- Practice expense (office) RVU3.81 · 100%
- Malpractice RVU0.00 · 0%
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.
Q4396 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$144.69
Q4390 identifies Ascendion. The wound measurement alone cannot distinguish these codes; the documented product determines the choice.
$144.69
Q4392 identifies Grafix Duo. Report Q4396 for Natalin, using the product record to verify the material applied.
Compare Q4396 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$144.69
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for Q4396 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
18,481
- Code
- Q4396
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.81 | × 1.137 | 4.3320 |
| Malpractice | 0.00 | × 0.579 | 0.0000 |
| Total RVUs | 4.3320 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$144.69
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 3.81 | 1.137 |
| Malpractice | 0 | 0.579 |
(0 × 1 + 3.81 × 1.137 + 0 × 0.579) × $33.4009 = $144.69
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
Q4396 billing questions
Can Q4396 be reported without an application procedure?
No. CMS designates Q4396 an add-on code that must be billed with a primary procedure.
How are units determined for Q4396?
The unit is one square centimeter of Natalin. Document the product and amount used so the reported units can be checked against the treatment record.
How is Q4396 different from Q4395?
Q4396 identifies Natalin; Q4395 identifies Acelagraft. Choose the product code that matches the graft documented for the encounter.
Does Q4396 include interpretation?
No. CMS classifies Q4396 as technical-component-only and identifies a separate code for interpretation. The interpretation must be performed and documented to support reporting it.
Which global period governs Q4396?
CMS pays this add-on code within the global period of its primary procedure. It is not reported as a standalone service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
18,478Q4393,,Surgraft ac per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,479Q4394,,Surgraft aca per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,480Q4395,,Acelagraft per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,481Q4396,,Natalin per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,482Q4397,,Summit aaa per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,483Q4398,,Summit ac per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
18,484Q4399,,Summit fx per sq cm,A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014