HCPCS code Q4186: EpiFix material2026 Medicare rate & RVUs in Illinois
Q4186 reports EpiFix amniotic membrane material by square centimeter when it is furnished with a primary wound procedure.
Medicare pays $116.19–$130.69 for Q4186 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 9 sections
What Q4186 covers
Q4186 identifies EpiFix, an amniotic membrane product used as a wound covering. Wound-care clinicians, podiatrists, and surgeons may apply it to chronic wounds such as diabetic foot ulcers or venous leg ulcers in office or hospital outpatient settings. The product code represents the material, not the clinician’s wound assessment or the application service.
Report one unit for each square centimeter represented by the product amount, supported by the product record and wound documentation. CMS classifies Q4186 as an add-on code: bill it only with a primary procedure, and its payment falls within that procedure’s global period. CMS also identifies it as technical-component-only, with a separate code covering interpretation. Pair it with the applicable wound procedure for the treated site and area; the record should identify the product, wound location, treated area, and amount used.
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 Q4186 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$116.19 to $130.69
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $127.89 | Unavailable |
| East St. Louis | $117.08 | Unavailable |
| Rest Of Illinois | $116.19 | Unavailable |
| Suburban Chicago | $130.69 | Unavailable |
How the Q4186 rate is calculated
Each of Q4186’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 · Q4186
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 Q4186
The CMS indicators that decide how Q4186 is paid alongside other services.
CMS payment indicators · Q4186
EpiFix material
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
Q4186 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4187Wound product
- Use Q4186 for EpiFix and Q4187 for Epicord. Both are product-specific codes with a square-centimeter unit, but they identify different materials.
- Q4188Wound product
- Q4188 identifies AmnioArmor, not EpiFix. Choose according to the product furnished, not simply because both are reported by area.
- 15271Skin substitute graft
- Q4186 reports the EpiFix material; 15271 reports an application procedure for qualifying trunk, arm, or leg wounds. They serve different parts of the encounter.
Q4186 billing questions
How is Q4186 different from Q4187?
Q4186 identifies EpiFix; Q4187 identifies Epicord. Select the code matching the product furnished, rather than choosing between them by wound site or area.
How many units should be reported?
Each Q4186 unit represents one square centimeter. Documentation should support the product amount reported and the wound area treated.
Can Q4186 be billed by itself?
No. CMS identifies Q4186 as an add-on code billed only with a primary procedure.
Is the wound application included in Q4186?
Q4186 identifies the EpiFix material. Report the applicable primary wound procedure for the application service when the procedure is performed.
What does technical-component-only mean for this code?
CMS classifies Q4186 as technical-component-only and indicates that a separate code covers 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
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