$119.62
Q4122 identifies Dermacell AWM, not TheraSkin. Select the product code that matches the material applied.
On this page
CMS RVU26D · Effective 2026-10-01
Q4121 Skin substitute Medicare reimbursement rates in Utah
Report Q4121 for TheraSkin human skin allograft used to cover a wound, with units based on square centimeters and an application procedure billed with it. Compare Q4121 office and facility rates across CMS payment localities in Utah.
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 Q4121 in Utah?
Utah 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
$119.62
1 of 1 localities have a supported rate.
Payment area: Utah
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 substitute product
About Q4121: TheraSkin wound coverage product
Report Q4121 for TheraSkin human skin allograft used to cover a wound, with units based on square centimeters and an application procedure billed with it.
Q4121 reports TheraSkin, a human skin allograft supplied for coverage of a wound bed, commonly in care of chronic diabetic foot and venous leg ulcers. It represents the graft material, not the clinician’s wound preparation or application work. Physicians, podiatrists, and other qualified practitioners may use it in outpatient wound clinics, offices, or hospital outpatient departments when a skin substitute is selected as part of wound care. The product is measured per square centimeter, so the product record and wound documentation should support the quantity reported.
Report Q4121 only with the applicable primary skin-substitute application procedure. CMS treats it as an add-on, with payment within that procedure’s global period. The CMS file assigns no work RVUs and 3.81 practice-expense RVUs in both office and facility settings. Q4121 is technical-component-only; a separate code covers interpretation. Documentation should identify TheraSkin, the wound location and dimensions, the quantity applied, and the associated application procedure so the product units and procedural service can be reconciled.
CMS billing rules for Q4121
- 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.
Q4121 compared with similar codes
Office rates for Utah, from the same CMS release.
$119.62
Q4124 represents Oasis tri-layer wound matrix. It is not interchangeable on the claim with TheraSkin; code the product actually used.
$119.62
Q4132 identifies Grafix Core products. Q4121 is specific to TheraSkin, so the product record determines which code applies.
Compare Q4121 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
Utah →
Office / nonfacility
$119.62
Facility
Unavailable
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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 Q4121 in Utah.
PPRRVU2026_Oct_nonQPP.csv
18,217
- Code
- Q4121
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.81 | × 0.940 | 3.5814 |
| Malpractice | 0.00 | × 0.898 | 0.0000 |
| Total RVUs | 3.5814 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$119.62
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 3.81 | 0.94 |
| Malpractice | 0 | 0.898 |
(0 × 1 + 3.81 × 0.94 + 0 × 0.898) × $33.4009 = $119.62
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.
Q4121 billing questions
What distinguishes Q4121 from another skin substitute product code?
Q4121 identifies TheraSkin specifically. Report the product code matching the graft material used, rather than choosing among products based only on wound type.
Does Q4121 include the wound application procedure?
No. Q4121 represents the TheraSkin product and is reported with the applicable primary skin-substitute application procedure.
How should units be determined?
Q4121 is measured per square centimeter. The product record and wound documentation should support the quantity reported.
How does the add-on status affect payment?
CMS requires Q4121 to be billed with a primary procedure and places its payment within that procedure’s global period.
Does Q4121 include interpretation?
CMS classifies Q4121 as technical-component-only; 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 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.
18,214Q4116,,Alloderm,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
18,215Q4117,,Hyalomatrix,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
18,216Q4118,,Matristem micromatrix,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,3,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
18,217Q4121,,Theraskin,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
18,218Q4122,,"Dermacell, awm, porous sq cm",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
18,219Q4123,,Alloskin,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
18,220Q4124,,Oasis tri-layer wound 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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985