HCPCS Q4254: Wound matrixMedicare rate & RVUs in Illinois
Q4254 reports NovaFix DL, an amniotic membrane wound covering, by the square centimeter used with a primary wound-treatment procedure.
Medicare pays $116.19–$130.69 for Q4254 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 Q4254 covers
NovaFix DL is a dual-layer amniotic membrane allograft used as a covering for wounds, including chronic or difficult-to-heal wounds. Wound-care clinicians, podiatrists, and surgeons may apply it to a prepared wound bed in outpatient or facility settings. Q4254 identifies the product, not the wound preparation or application service.
Report the documented square centimeters of NovaFix DL used, and pair the code with the primary procedure. The record should identify the product, the treated wound, the amount used, and the application procedure. CMS classifies Q4254 as an add-on code: it is billed only with a primary procedure and paid within that procedure's global period. It is also a technical-component-only code; a separate code covers interpretation. The primary procedure accounts for the application work, while Q4254 identifies the product amount.
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 Q4254 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 Q4254 rate is calculated
Each of Q4254’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 · Q4254
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 Q4254
The CMS indicators that decide how Q4254 is paid alongside other services.
CMS payment indicators · Q4254
Wound matrix
| 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. |
Q4254 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4253Amniotic membrane
- Q4253 identifies Zenith amniotic membrane. Use Q4254 only when NovaFix DL is the product applied.
- Q4255Wound product
- Q4255 identifies Reguard for topical use. Q4254 identifies NovaFix DL and is measured per square centimeter.
- 15271Skin substitute graft
- 15271 reports the primary skin-substitute application service for qualifying wounds; Q4254 identifies the NovaFix DL product amount.
Q4254 billing questions
When should Q4254 be selected instead of another skin-substitute product code?
Use Q4254 when the product applied is NovaFix DL. Other product-specific codes identify different products, even when they are also used as wound coverings.
Can Q4254 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure.
How should the quantity be reported?
Report the square centimeters of NovaFix DL used, supported by documentation of the treated wound and product amount.
Does Q4254 include the wound application service?
No. Q4254 identifies the product amount; report the applicable primary procedure for the wound treatment.
What does the technical-component-only classification mean?
Q4254 represents the technical component. CMS specifies that a separate code covers interpretation.
What procedure codes may be reported with Q4254?
Skin-substitute application codes such as 15271 and, when additional treated area qualifies, 15272 may be reported for the application service. Q4254 remains the product-specific line for NovaFix DL.
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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