HCPCS Q4166: Wound matrixMedicare rate & RVUs in Utah
Reports Cytal extracellular matrix material used on a wound bed, measured by area and billed with the related wound application procedure.
Medicare pays $119.62 for Q4166 in the office in Utah (Utah). 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 Q4166 covers
Cytal is an extracellular matrix wound product derived from porcine urinary bladder tissue. A wound-care clinician may apply it to a prepared wound bed, including in the treatment of chronic wounds such as diabetic foot or venous leg ulcers. The product amount is reported by the square centimeter, rather than by the number of wounds or a time increment.
Report Q4166 with the primary wound application procedure for the same treatment, using documentation that identifies Cytal, the treated wound site, and the quantity applied in square centimeters. CMS classifies this as an add-on code: it must be billed with a primary procedure and is paid within that procedure's global period. CMS also identifies it as technical-component-only, with interpretation covered by a separate code rather than this line. The application service and the Cytal material are distinct reported items.
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.
Q4166 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $119.62 | Unavailable |
How the Q4166 rate is calculated
Each of Q4166’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 · Q4166
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 Q4166
The CMS indicators that decide how Q4166 is paid alongside other services.
CMS payment indicators · Q4166
Wound matrix
| 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. |
Q4166 compared with similar codes
Compare codes
Q4166 vs Q4165 vs Q4167 vs 15271: national Medicare rates
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How to choose
- Q4165Wound matrix
- Q4165 identifies Keramatrix or Kerasorb. Q4166 is specific to Cytal; select according to the product actually furnished.
- Q4167Wound product
- Q4167 identifies TruSkin, not Cytal. Both are area-based wound product codes, but the product determines which code applies.
- 15271Skin substitute graft
- 15271 reports the wound application service for qualifying trunk or extremity sites. Q4166 reports the Cytal material and must accompany a primary procedure.
Q4166 billing questions
When is Q4166 reported instead of another wound product code?
Use Q4166 when the material furnished is Cytal. Other wound matrices have their own HCPCS codes, even when they are applied to a similar wound.
Can Q4166 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure; it is paid within that procedure's global period.
Is the wound application included in Q4166?
Q4166 reports the Cytal material by area, while the primary wound application procedure reports the clinician's application service. Document both the product amount and the application performed.
What supports the number of units?
Document the Cytal quantity used in square centimeters, along with the wound site and product identity. The code is measured by area, not by wound count or time.
Does Q4166 include a professional interpretation?
CMS classifies Q4166 as technical-component-only and assigns interpretation to a separate code. Q4166 itself reports the Cytal material.
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
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