HCPCS Q4265: Skin substituteMedicare rate & RVUs in Oregon
Report Neostim TL by square centimeter when this specific wound product is furnished with a qualifying primary application procedure.
Medicare pays $126.75–$141.38 for Q4265 in the office in Oregon, from Rest Of Oregon to Portland. 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 Q4265 covers
Q4265 identifies the Neostim TL wound product by the square centimeter. It represents the product used during wound treatment, rather than the clinician’s wound assessment or the application procedure itself. Wound care specialists, surgeons, and other clinicians may use skin substitute products in outpatient wound clinics, physician offices, or hospital outpatient departments for wounds requiring advanced wound management.
Report Q4265 only with a primary procedure, using the product actually furnished and the applicable quantity in square centimeters. Documentation should identify Neostim TL, the wound treated, the area for which product was used, and the associated application procedure. CMS treats Q4265 as an add-on code paid within the primary procedure’s global period. CMS also classifies it as technical-component-only; the interpretation is covered by a separate code. The product code does not replace the application code, which is selected based on the wound site and applicable area criteria.
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 Q4265 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $141.38 | Unavailable |
| Rest Of Oregon | $126.75 | Unavailable |
How the Q4265 rate is calculated
Each of Q4265’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 · Q4265
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.00Practice expense 3.81Malpractice 0.00
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for Q4265
The CMS indicators that decide how Q4265 is paid alongside other services.
CMS payment indicators · Q4265
Skin substitute
| 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. |
Q4265 compared with similar codes
Compare codes
Q4265 vs Q4266 vs Q4267 vs 15271 vs 15275: national Medicare rates
Swap in your local Medicare rate.
How to choose
- Q4266Wound graft
- Q4266 identifies Neostim without the TL designation. Match the claim to the specific product used.
- Q4267Wound product
- Q4267 identifies Neostim DL, a distinct product form. Do not substitute it for Neostim TL based only on wound site or size.
- 15271Skin substitute graft
- Q4265 reports the Neostim TL product by area; 15271 reports application to qualifying trunk, arm, or leg wounds.
- 15275Skin substitute
- Q4265 identifies the product, while 15275 reports application at its specified anatomic sites. Select the application code by site and area criteria.
Q4265 billing questions
How is Q4265 distinguished from other Neostim codes?
Use Q4265 only when the product furnished is Neostim TL. Neostim and Neostim DL have separate HCPCS codes, so verify the product identity rather than choosing by wound characteristics.
What primary service must accompany Q4265?
CMS identifies Q4265 as an add-on code, so it is billed with a primary procedure. For skin substitute application, the applicable procedure code depends on the wound site and area.
What documentation supports the units?
Document the Neostim TL product, the wound site, the area treated, and the quantity used in square centimeters, along with the associated primary procedure.
Is the application procedure included in Q4265?
No. Q4265 identifies the product; the wound application is represented by its own primary procedure code.
How does CMS treat the code’s component and global status?
CMS classifies Q4265 as technical-component-only, with interpretation covered separately. It is paid within the global period of the primary procedure.
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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