$130.95
Q4105 identifies Integra DRT or Omnigraft. Use Q4104 for Integra BMWD; the product documented as applied determines the supply code.
On this page
CMS RVU26D · Effective 2026-10-01
Q4104 Wound matrix Medicare reimbursement rates in Minnesota
Reports Integra Bilayer Wound Matrix used as a wound covering, paired with the primary application procedure and documented by product and area used. Compare Q4104 office and facility rates across CMS payment localities in Minnesota.
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 Q4104 in Minnesota?
Minnesota 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
$130.95
1 of 1 localities have a supported rate.
Payment area: Minnesota
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.
Skin substitute products
About Q4104: Integra bilayer wound matrix supply
Reports Integra Bilayer Wound Matrix used as a wound covering, paired with the primary application procedure and documented by product and area used.
Q4104 identifies Integra Bilayer Wound Matrix (BMWD), a collagen-based wound matrix with a protective outer layer used to cover partial- and full-thickness wounds. Typical settings include wound-care clinics, outpatient surgery, and hospital-based wound treatment. Clinicians may use it for chronic ulcers, surgical wounds, traumatic wounds, or burns; the treating clinician applies the product to the prepared wound.
Report the product with the primary wound or skin-substitute application procedure, not as a stand-alone service. CMS classifies Q4104 as an add-on paid within the primary procedure’s global period. The code represents the product rather than the clinician’s application work; document the product used and the wound area treated, and report units according to the applicable HCPCS descriptor. CMS also identifies Q4104 as technical-component-only, with interpretation covered by a separate code when applicable.
CMS billing rules for Q4104
- 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.
Q4104 compared with similar codes
Office rates for Minnesota, from the same CMS release.
$130.95
Q4108 identifies Integra Matrix rather than BMWD. Distinguish them by the specific product used, not simply by the wound being treated.
$130.95
Q4102 identifies Oasis wound matrix. Q4104 is specific to Integra BMWD, so select the code matching the product used.
Compare Q4104 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
Minnesota →
Office / nonfacility
$130.95
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 Q4104 in Minnesota.
PPRRVU2026_Oct_nonQPP.csv
18,204
- Code
- Q4104
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
66
- Locality
- Minnesota
- Physician work
- 1.000
- Practice expense
- 1.029
- Malpractice
- 0.296
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.81 | × 1.029 | 3.9205 |
| Malpractice | 0.00 | × 0.296 | 0.0000 |
| Total RVUs | 3.9205 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Minnesota$130.95
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 3.81 | 1.029 |
| Malpractice | 0 | 0.296 |
(0 × 1 + 3.81 × 1.029 + 0 × 0.296) × $33.4009 = $130.95
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.
Q4104 billing questions
Can Q4104 be reported by itself?
No. CMS identifies it as an add-on that must be billed with a primary procedure; payment falls within that procedure’s global period.
Which application procedure is commonly paired with Q4104?
Pair the product with the applicable skin-substitute application procedure, such as the 15271–15278 family. Select the application code based on the wound site and area treated.
How should units be supported?
Document the BMWD product used and the wound area treated. Report units according to the applicable HCPCS descriptor and the documented quantity.
Does Q4104 include the clinician’s application work?
No. Q4104 identifies the product. The primary procedure represents the application service, and CMS places Q4104 within that procedure’s global period.
What does the technical-component-only designation mean?
CMS identifies Q4104 as technical-component-only and states that interpretation is covered by a separate code when applicable.
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.
18,201Q4101,,Apligraf,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
18,202Q4102,,Oasis wound matrix,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
18,203Q4103,,Oasis burn matrix,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
18,204Q4104,,Integra bmwd,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
18,205Q4105,,Integra drt or omnigraft,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
18,206Q4107,,Graftjacket,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
18,207Q4108,,Integra matrix,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
6314212,MA,99,REST OF MASSACHUSETTS,1.016,1.053,0.797
6408202,MI,01,DETROIT,1.000,0.965,1.686
6508202,MI,99,REST OF MICHIGAN,1.000,0.913,1.129
6606202,MN,00,MINNESOTA,1.000,1.029,0.296
6707302,MS,00,MISSISSIPPI,1.000,0.861,0.739
6805302,MO,02,METROPOLITAN KANSAS CITY,1.000,0.939,0.977
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002