Q4113
No office rateGraftjacket xpress
Q4113 identifies GraftJacket Xpress. Use Q4107 for GraftJacket, and match the code to the product actually applied.
On this page
CMS RVU26D · Effective 2026-10-01
Q4107 GraftJacket Medicare reimbursement rates in Rhode Island
Report Q4107 for GraftJacket acellular dermal matrix used with a qualifying graft-application procedure, based on the product amount applied. Compare Q4107 office and facility rates across CMS payment localities in Rhode Island.
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 Q4107 in Rhode Island?
Rhode Island 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
$131.46
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 substitutes
About Q4107: GraftJacket dermal matrix supply
Report Q4107 for GraftJacket acellular dermal matrix used with a qualifying graft-application procedure, based on the product amount applied.
Q4107 identifies GraftJacket, an acellular dermal matrix used as a graft material in wound care and soft-tissue reconstruction. It may be used in treating chronic wounds, such as diabetic foot or venous leg ulcers, and in surgical reconstruction. The clinician applies the material to the prepared site; the product code represents the graft material, not the work of preparing the wound or applying the graft.
Report the product code with the appropriate primary procedure, selecting that procedure according to the treatment site and the extent of the application. Documentation should identify GraftJacket, the treated site, and the amount used; Q4107 is reported per square centimeter. CMS classifies this as an add-on code, so it is billed only with a primary procedure and paid within that procedure’s global period. It is a technical-component-only code, with interpretation covered by a separate code.
CMS billing rules for Q4107
- 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.
Q4107 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
Q4112
No office rateCymetra injectable
Q4112 is for injectable Cymetra. Q4107 identifies GraftJacket matrix material rather than the injectable product.
$131.46
Q4105 identifies Integra DRT or Omnigraft, not GraftJacket. Choose according to the specific graft product used.
Compare Q4107 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
Rhode Island →
Office / nonfacility
$131.46
Facility
Unavailable
Need rates for a whole code list?
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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 Q4107 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
18,206
- Code
- Q4107
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.019 | 0.0000 |
| Practice expense | 3.81 | × 1.033 | 3.9357 |
| Malpractice | 0.00 | × 0.892 | 0.0000 |
| Total RVUs | 3.9357 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$131.46
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1.019 |
| Practice expense | 3.81 | 1.033 |
| Malpractice | 0 | 0.892 |
(0 × 1.019 + 3.81 × 1.033 + 0 × 0.892) × $33.4009 = $131.46
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.
Q4107 billing questions
Can Q4107 be reported by itself?
No. CMS identifies Q4107 as an add-on code, so it must be billed with a primary procedure.
Is Q4107 the wound application procedure?
No. Q4107 identifies the GraftJacket material. Report the appropriate application procedure separately as the primary procedure.
How should the quantity be documented?
Document the amount of GraftJacket used in square centimeters and the site where it was applied.
Does Q4107 include interpretation?
No. CMS classifies it as technical-component-only; a separate code covers interpretation.
How does Q4107 differ from Q4113?
Both identify GraftJacket products, but Q4113 is for GraftJacket Xpress. Select the code matching the specific product used.
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.
18,203Q4103,,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
18,208Q4110,,Primatrix,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
18,209Q4111,,Gammagraft,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537