$119.62
Q4204 identifies Xwrap. Choose the code matching the product applied rather than treating the two product codes as interchangeable.
On this page
CMS RVU26D · Effective 2026-10-01
Q4205 Membrane graft Medicare reimbursement rates in Utah
Q4205 reports membrane graft or wrap material applied during a primary wound-care or surgical procedure, with units based on the treated area. Compare Q4205 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 Q4205 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.
Wound care supplies
About Q4205: Membrane graft or wrap supply
Q4205 reports membrane graft or wrap material applied during a primary wound-care or surgical procedure, with units based on the treated area.
Q4205 identifies membrane material applied as a graft or wrap to cover a treated wound or operative site. It represents the product, not the clinician’s evaluation or application work. Wound-care clinicians and surgeons may report it when they use the specified material as part of wound treatment or a surgical procedure.
Report the quantity in square centimeters and document the product, treated site, area used, and related primary procedure. CMS classifies Q4205 as an add-on: it must be billed with a primary procedure, and its payment is within that procedure’s global period. It is a technical-component-only code; a separate code covers interpretation.
CMS billing rules for Q4205
- 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.
Q4205 compared with similar codes
Office rates for Utah, from the same CMS release.
$119.62
Q4211 identifies amnion bio or axobio; Q4205 identifies the membrane graft or wrap product. The product used determines the code.
Q4206
No office rateFluid flow or fluid gf 1 cc
Q4206 describes a different product reported by cubic centimeter. Q4205 is the membrane product measured by square centimeter.
Compare Q4205 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 Q4205 in Utah.
PPRRVU2026_Oct_nonQPP.csv
18,297
- Code
- Q4205
- 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.
Q4205 billing questions
Can Q4205 be billed by itself?
No. CMS identifies it as an add-on that must be billed with a primary procedure.
How should units be counted?
Count the membrane material in square centimeters. Document the area used at the treated site.
What documentation supports Q4205?
Record the product used, the treated site, the area applied, and the primary procedure performed.
How does the global period affect payment?
Payment for Q4205 falls within the global period of the primary procedure reported with it.
Does Q4205 include interpretation?
No. CMS classifies it 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.
18,294Q4202,,"Keroxx (2.5g/cc), 1cc",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
18,295Q4203,,"Derma-gide, 1 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
18,296Q4204,,Xwrap 1 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
18,297Q4205,,Membrane graft or wrap 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
18,298Q4206,,Fluid flow or fluid gf 1 cc,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
18,299Q4207,,"Carbon life, per sq cm",A,,0.00,3.81,,3.81,NA,0.00,3.81,3.81,3,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
18,300Q4208,,Novafix per 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
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