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See a sample rate comparisonHCPCS Q4104 (Integra Bilayer Wound Matrix) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Skin Substitutes and Biologicals |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for Q4104 |
| Medicare Payment Limit | $51.003  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS Q4104 by major payers:
$42.43
$53.13
$53.26
$53.39
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HCPCS Q4104
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$108.97Published rateNorthside Hospital, Inc., Northside Hospital Duluth
$55.54Published rateChatuge Regional Hospital Inc
$52.40Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$49.53Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$45.09Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS Q4104 vs. Other Skin Substitutes and Biologicals Codes
The HCPCS Q4104 code is part of the Temporary Codes services used for Skin Substitutes and Biologicals. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS Q4104 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| Q4103-HCPCS | Low | Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4104-HCPCS | Low | Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4105-HCPCS | Low | Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q4104. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q4104 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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