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See a sample rate comparisonHCPCS Q4197 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.
Puraply xt, 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 Q4197 |
National average reimbursement for HCPCS Q4197 by major payers:
$107.19
$106.37
$112.04
$104.50
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HCPCS Q4197
5 of 25 sample ratesHigher to lower in this preview
The Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$467.63Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$270.56Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$130.36Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$122.37Published rateChi Memorial Hospital
Chi Memorial Hospital - Georgia
$72.63Published rate
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See a sample payer proposalHCPCS Q4197 vs. Other Skin Substitutes and Biologicals Codes
The HCPCS Q4197 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 Q4197 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 |
|---|---|---|
| Q4196-HCPCS | Low | Puraply am, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4197-HCPCS | Low | Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4198-HCPCS | Low | Genesis amniotic membrane, 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 Q4197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q4197 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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