HCPCS code Q4243: Wound product2026 Medicare rate & RVUs in Ohio
Report AmchoMatrix by the square centimeter when this wound product is furnished with a primary wound-application procedure.
Medicare pays $116.19 for Q4243 in the office in Ohio (Ohio). 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 Q4243 covers
Q4243 identifies AmchoMatrix, a wound product supplied and measured by area. It may be used in wound care when a clinician applies the product to a wound as part of a primary procedure. Wound-care clinicians, podiatrists, and surgeons may encounter it in outpatient wound clinics, offices, or hospital settings. The product code represents the material, not the clinician’s wound preparation or application service.
Report the quantity in square centimeters and pair Q4243 with the primary procedure for the wound application. The record should identify the product and document the treated wound and the amount furnished. CMS classifies Q4243 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.
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.
Q4243 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $116.19 | Unavailable |
How the Q4243 rate is calculated
Each of Q4243’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 · Q4243
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 Q4243
The CMS indicators that decide how Q4243 is paid alongside other services.
CMS payment indicators · Q4243
Wound product
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 3 | Technical component only. |
Q4243 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4242Amniocyte plus, per 0.5 cc
- Q4242 identifies Amniocyte Plus and uses a 0.5-cc unit. Q4243 identifies AmchoMatrix and uses a square-centimeter unit.
- Q4232Corplex graft
- Q4232 identifies Corplex, while Q4243 identifies AmchoMatrix. Both are measured per square centimeter, so distinguish them by the product furnished.
- Q4247Amniotext patch
- Q4247 identifies the Amniotext patch and is measured per square centimeter. Q4243 is the AmchoMatrix product; choose according to the product used.
Q4243 billing questions
How is Q4243 different from Q4242?
Q4243 identifies AmchoMatrix and is measured per square centimeter. Q4242 identifies Amniocyte Plus and is measured per 0.5 cc; select the code for the product actually furnished.
Can Q4243 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure. For wound application, the primary procedure may be selected from the applicable skin-substitute application codes.
What documentation supports the units?
Document that AmchoMatrix was used, identify the treated wound, and record the amount furnished in square centimeters.
Does Q4243 include interpretation?
No. CMS classifies Q4243 as technical-component-only; a separate code covers interpretation.
How does the global-period rule affect payment?
Q4243 is paid within the global period of the primary procedure with which it is reported.
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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