HCPCS Q4342: Skin substituteMedicare rate & RVUs in Texas
Q4342 reports Theramend wound-covering product by square centimeter when supplied with an appropriate primary wound or skin-substitute application procedure.
Medicare pays $115.80–$134.64 for Q4342 in the office in Texas, from Beaumont to Austin. 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 Q4342 covers
Q4342 identifies Theramend, a wound-covering tissue product, measured by the square centimeter. It represents the product supplied for application to a wound, not the clinician’s work applying it. Wound care clinicians, surgeons, and other practitioners who treat wounds may use it in outpatient or facility settings when Theramend is applied as part of a wound treatment. The procedure code describes the application; Q4342 identifies the specific product used.
Report the quantity in square centimeters and document the product name, the treated wound, and the amount applied. Pair Q4342 with the applicable primary application procedure, such as billing code 15271 or 15275 when appropriate to the site and wound area. CMS treats this as an add-on code paid within the primary procedure’s global period, not as a standalone service. CMS classifies it as technical-component-only; a separate code covers interpretation. CMS assigns no physician-work RVUs to Q4342.
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 Q4342 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$115.80 to $134.64
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $134.64 | Unavailable |
| Beaumont | $115.80 | Unavailable |
| Brazoria | $126.11 | Unavailable |
| Dallas | $126.75 | Unavailable |
| Fort Worth | $125.48 | Unavailable |
| Galveston | $126.37 | Unavailable |
| Houston | $126.37 | Unavailable |
| Rest Of Texas | $120.77 | Unavailable |
How the Q4342 rate is calculated
Each of Q4342’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 · Q4342
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 Q4342
The CMS indicators that decide how Q4342 is paid alongside other services.
CMS payment indicators · Q4342
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. |
Q4342 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q4341Wound matrix
- Q4341 identifies Simplimax, while Q4342 identifies Theramend. Select the code for the product actually used, not by wound location or size.
- Q4343Wound matrix
- Q4343 identifies Dermacyte AC Matrix; Q4342 identifies Theramend. These product codes are distinguished by the product supplied.
- 15271Skin substitute graft
- billing code 15271 reports an application procedure for eligible wound sites and areas; Q4342 reports the Theramend product by square centimeter and is billed with a primary procedure.
Q4342 billing questions
Can Q4342 be billed by itself?
No. CMS identifies Q4342 as an add-on code that must be billed with a primary procedure, with payment included within that procedure’s global period.
How should the number of units be determined?
Report the Theramend quantity by square centimeter. Documentation should identify the product and the amount applied to the treated wound.
Which application code is reported with Q4342?
Use the primary skin-substitute application procedure appropriate to the wound site and area, such as billing code 15271 or 15275 when applicable.
Does Q4342 include the clinician’s application work?
No. Q4342 identifies the Theramend product; the primary procedure code represents the application service.
Does Q4342 include interpretation?
No. CMS classifies Q4342 as technical-component-only and specifies that a separate code covers interpretation.
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
Fee sheets
Put Q4342 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →