HCPCS Q4396: Natalin graftMedicare rate & RVUs in Texas
Report Q4396 for each square centimeter of Natalin used with a primary graft application procedure to treat a wound.
Medicare pays $115.80–$134.64 for Q4396 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 Q4396 covers
Q4396 identifies Natalin by product and measures the material in square centimeters. A wound care clinician, podiatrist, or surgeon may use it while treating a wound in an office or facility. The code describes the Natalin material rather than the work of preparing the wound and applying it. Select it only when the treatment record identifies Natalin; a different graft product calls for its own product code.
Report the number of square centimeters of Natalin used, supported by the wound measurements, product record, and amount documented for the application. Link Q4396 to the primary procedure performed at that encounter: CMS classifies it as an add-on code billed only with a primary procedure and paid within that procedure’s global period. CMS also classifies Q4396 as technical-component-only. A separate code covers interpretation when interpretation is performed and documented; Q4396 itself represents the technical portion.
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 Q4396 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 Q4396 rate is calculated
Each of Q4396’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 · Q4396
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 Q4396
The CMS indicators that decide how Q4396 is paid alongside other services.
CMS payment indicators · Q4396
Natalin graft
| 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. |
Q4396 compared with similar codes
Compare codes
Q4396 vs Q4395 vs Q4390 vs Q4392: national Medicare rates
Swap in your local Medicare rate.
How to choose
- Q4395Acelagraft
- Both are measured per square centimeter, but Q4395 is for Acelagraft. Use Q4396 when the documented product is Natalin.
- Q4390Skin substitute
- Q4390 identifies Ascendion. The wound measurement alone cannot distinguish these codes; the documented product determines the choice.
- Q4392Skin substitute
- Q4392 identifies Grafix Duo. Report Q4396 for Natalin, using the product record to verify the material applied.
Q4396 billing questions
Can Q4396 be reported without an application procedure?
No. CMS designates Q4396 an add-on code that must be billed with a primary procedure.
How are units determined for Q4396?
The unit is one square centimeter of Natalin. Document the product and amount used so the reported units can be checked against the treatment record.
How is Q4396 different from Q4395?
Q4396 identifies Natalin; Q4395 identifies Acelagraft. Choose the product code that matches the graft documented for the encounter.
Does Q4396 include interpretation?
No. CMS classifies Q4396 as technical-component-only and identifies a separate code for interpretation. The interpretation must be performed and documented to support reporting it.
Which global period governs Q4396?
CMS pays this add-on code within the global period of its primary procedure. It is not reported as a standalone service.
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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