$121.91
Q4366 identifies DL Amnio Bur X-Mem, while Q4367 identifies Amniocore SL. Select the product-specific code that matches the material documented as applied.
On this page
CMS RVU26D · Effective 2026-10-01
Q4367 Amniotic tissue product Medicare reimbursement rates in Wisconsin
Reports each square centimeter of Amniocore SL amniotic tissue used to cover a wound, alongside the applicable primary wound procedure. Compare Q4367 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 Q4367 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.
Skin substitute product
About Q4367: Amniocore SL wound graft material
Reports each square centimeter of Amniocore SL amniotic tissue used to cover a wound, alongside the applicable primary wound procedure.
Q4367 identifies Amniocore SL, an amniotic tissue product applied to a wound bed as a covering. It may be used by wound care clinicians or surgeons treating wounds such as diabetic foot ulcers or venous leg ulcers. The code identifies the product by brand and billed area, rather than the clinician’s evaluation of the wound or the application work itself.
Report units based on the square centimeters of product applied, and document the product, wound site, amount used, and associated procedure. CMS classifies Q4367 as an add-on code: report it only with a primary procedure, and payment falls within that procedure’s global period. CMS also classifies it as technical-component-only, with interpretation covered by a separate code. The primary application code depends on the wound site and area; for example, the applicable skin-substitute application code may be from the 15271–15278 series.
CMS billing rules for Q4367
- 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.
Q4367 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$121.91
Q4368 identifies Amchothick rather than Amniocore SL. The wound site does not determine which of these product codes to report.
$148.84
15271 reports the primary application procedure for qualifying trunk, arm, or leg wounds; Q4367 identifies the Amniocore SL product used with a primary procedure.
$151.75
15275 reports the primary application procedure for qualifying wounds at specified other sites; Q4367 reports the product, not the application work.
Compare Q4367 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 Q4367 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
18,454
- Code
- Q4367
- 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.
Q4367 billing questions
Can Q4367 be reported by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure. Pair it with the applicable wound application procedure.
How are units determined?
Report the square centimeters of Amniocore SL applied. The record should support the product identity and the area used.
Which application code should accompany it?
Choose the primary skin-substitute application code based on wound location and area. Codes in the 15271–15278 series may apply.
Is there a separate professional interpretation component?
CMS classifies Q4367 as technical-component-only and indicates that a separate code covers interpretation.
How does Q4367 differ from Q4368?
Q4367 identifies Amniocore SL; Q4368 identifies Amchothick. Use the code matching the product actually applied, not one selected by wound location.
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.
18,451Q4364,,Am bur xp mem xpl hy p 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
18,452Q4365,,Amnio bur dl mem 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
18,453Q4366,,Dl amnio bur x-mem 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
18,454Q4367,,"Amniocore 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
18,455Q4368,,Amchothick 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
18,456Q4369,,Amnioplast 3 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
18,457Q4370,,Aeroguard 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,,,,,,