$121.91
Q4341 identifies Simplimax, while Q4342 identifies Theramend. Select the code for the product actually used, not by wound location or size.
On this page
CMS RVU26D · Effective 2026-10-01
Q4342 Skin substitute Medicare reimbursement rates in Wisconsin
Q4342 reports Theramend wound-covering product by square centimeter when supplied with an appropriate primary wound or skin-substitute application procedure. Compare Q4342 office and facility rates across CMS payment localities in Wisconsin.
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 Q4342 in Wisconsin?
Wisconsin 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
$121.91
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 product
About Q4342: Theramend skin substitute product
Q4342 reports Theramend wound-covering product by square centimeter when supplied with an appropriate primary wound or skin-substitute application procedure.
Q4342 identifies Theramend, a wound-covering tissue product, measured by the square centimeter. It represents the product supplied for application to a wound, not the clinician’s work applying it. Wound care clinicians, surgeons, and other practitioners who treat wounds may use it in outpatient or facility settings when Theramend is applied as part of a wound treatment. The procedure code describes the application; Q4342 identifies the specific product used.
Report the quantity in square centimeters and document the product name, the treated wound, and the amount applied. Pair Q4342 with the applicable primary application procedure, such as CPT 15271 or 15275 when appropriate to the site and wound area. CMS treats this as an add-on code paid within the primary procedure’s global period, not as a standalone service. CMS classifies it as technical-component-only; a separate code covers interpretation. CMS assigns no physician-work RVUs to Q4342.
CMS billing rules for Q4342
- 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.
Q4342 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$121.91
Q4343 identifies Dermacyte AC Matrix; Q4342 identifies Theramend. These product codes are distinguished by the product supplied.
$148.84
CPT 15271 reports an application procedure for eligible wound sites and areas; Q4342 reports the Theramend product by square centimeter and is billed with a primary procedure.
Compare Q4342 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
Wisconsin →
Office / nonfacility
$121.91
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 Q4342 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
18,429
- Code
- Q4342
- Physician work
- 0.00
- Practice expense
- 3.81
- Malpractice
- 0.00
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 3.81 | × 0.958 | 3.6500 |
| Malpractice | 0.00 | × 0.308 | 0.0000 |
| Total RVUs | 3.6500 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$121.91
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 3.81 | 0.958 |
| Malpractice | 0 | 0.308 |
(0 × 1 + 3.81 × 0.958 + 0 × 0.308) × $33.4009 = $121.91
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.
Q4342 billing questions
Can Q4342 be billed by itself?
No. CMS identifies Q4342 as an add-on code that must be billed with a primary procedure, with payment included within that procedure’s global period.
How should the number of units be determined?
Report the Theramend quantity by square centimeter. Documentation should identify the product and the amount applied to the treated wound.
Which application code is reported with Q4342?
Use the primary skin-substitute application procedure appropriate to the wound site and area, such as CPT 15271 or 15275 when applicable.
Does Q4342 include the clinician’s application work?
No. Q4342 identifies the Theramend product; the primary procedure code represents the application service.
Does Q4342 include interpretation?
No. CMS classifies Q4342 as technical-component-only and specifies that 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.
18,426Q4339,,"Artacent vericlen, 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
18,427Q4340,,"Simpligraft, 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
18,428Q4341,,"Simplimax, 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
18,429Q4342,,"Theramend, 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
18,430Q4343,,Dermacyte ac matrx 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
18,431Q4344,,"Tri membrane wrap, 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
18,432Q4345,,Matrix hd allogrft 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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,