$119.62
Q4268 identifies Surgraft FT, while Q4269 identifies Surgraft XT. Use the code matching the product supplied.
On this page
CMS RVU26D · Effective 2026-10-01
Q4269 Surgraft XT Medicare reimbursement rates in Utah
Reports the Surgraft XT wound tissue product by area when supplied for a wound treatment and billed with its primary procedure. Compare Q4269 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 Q4269 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
About Q4269: Surgraft XT wound tissue product
Reports the Surgraft XT wound tissue product by area when supplied for a wound treatment and billed with its primary procedure.
Q4269 reports Surgraft XT by the square centimeter as a wound tissue product used in wound treatment. It may be encountered in outpatient wound clinics, hospital departments, and office-based wound care when a clinician applies the product to a wound. The product code represents the tissue product, not the clinician’s wound assessment or the application service itself.
Report the measured area of Surgraft XT supplied, supported by the product record and documentation of the treated wound and amount used. This is an add-on code: bill it only with a qualifying primary procedure, and CMS pays it within that procedure’s global period. CMS classifies it as technical-component-only; a separate code covers interpretation. The record should identify Surgraft XT specifically so it is distinguishable from other products in the Surgraft series.
CMS billing rules for Q4269
- 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.
Q4269 compared with similar codes
Office rates for Utah, from the same CMS release.
$119.62
Q4263 identifies Surgraft TL rather than Surgraft XT. The product identity, not the wound location, distinguishes these codes.
$151.14
15271 reports the wound application procedure for qualifying trunk, arm, or leg sites; Q4269 reports the Surgraft XT product used with a primary procedure.
Compare Q4269 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 Q4269 in Utah.
PPRRVU2026_Oct_nonQPP.csv
18,357
- Code
- Q4269
- 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.
Q4269 billing questions
Can Q4269 be billed by itself?
No. CMS classifies it as an add-on code, so report it only with a qualifying primary procedure.
How are units determined?
Report the area of Surgraft XT in square centimeters. Document the area treated and the product quantity supplied.
Is the wound application included in Q4269?
Q4269 reports the product. The primary procedure represents the wound application and must be billed with this add-on code.
What documentation distinguishes Q4269 from other Surgraft codes?
Identify the product as Surgraft XT and record the area supplied. Do not select a Surgraft sibling code based only on the treated wound.
Does Q4269 include interpretation?
No. CMS classifies Q4269 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.
18,354Q4266,,Neostim 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
18,355Q4267,,Neostim dl 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
18,356Q4268,,Surgraft ft 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
18,357Q4269,,Surgraft xt 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
18,358Q4270,,Complete sl 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
18,359Q4271,,Complete ft 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
18,360Q4272,,"Esano a, 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