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HCPCS Q4105 (Integra Omnigraft Dermal Regeneration Matrix) Fee Schedule

Last Verified: December 2025

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 dermal regeneration template (DRT) or integra omnigraft dermal regeneration matrix, per square centimeter
Key FactDetail
Service Type

Temporary Codes

Skin Substitutes and Biologicals

Complexity LevelLow
Medicare Payment Limit
$26.944BuyandBill.com
WAC Price
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National average reimbursement for HCPCS Q4105 by major payers:

bcbs

$30.20

uhc

$37.33

aetna

$41.49

cigna

$37.46

Preview provider-level rates for...
For billing codeHCPCS Q4105
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS Q4105

United
Q4105$55.751073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$23.371255478004 - CHRISTOPHER RAIO111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTERNYEmergency Medicine Physician (207P00000X)
United
Q4105$25.341073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$25.211255478004 - CHRISTOPHER RAIO111635088 - MERCY MEDICAL CENTERNYEmergency Medicine Physician (207P00000X)
United
Q4105$51.681073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$25.341255478004 - CHRISTOPHER RAIO208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PCNYEmergency Medicine Physician (207P00000X)
United
Q4105$30.281831538743 - JACOB HOLLOWAY273818647GAGeneral Acute Care Hospital (282N00000X)
United
Q4105$30.701609860360 - OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, ASSUMPTION COMMUNITY HOSPITAL721495500 - (LA) OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INCLARural Acute Care Hospital (282NR1301X)
United
Q4105$25.341073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$51.681073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$55.751073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$51.681073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$55.751073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q4105$54.641073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
Q4105$25.341073502985 - CHU CHEN42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS Q4105 vs. Other Skin Substitutes and Biologicals Codes

The HCPCS Q4105 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 Q4105 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.

CodeComplexityDescription
Q4104-HCPCSLowIntegra bilayer matrix wound dressing (BMWD), per square centimeter
Q4105-HCPCSLowIntegra dermal regeneration template (DRT) or integra omnigraft dermal regeneration matrix, per square centimeter
Q4106-HCPCSLowDermagraft, per square centimeter

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q4105. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the Q4105 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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