HCPCS Q4205 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Temporary Codes • Skin Substitutes and Biologicals |
| Complexity Level | High |
| CMS | $1,190.44 Drug ASP |
National average reimbursement for HCPCS Q4205 by major payers:
$1,031.97
$1,345.75
$1,375.92
$1,388.98
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS Q4205 | ||||||
United | Q4205 | $1310.44 | 1376516864 - MICHAEL VERNI | 331011618 - (NV) MICHAEL P VERNI MD LTD | NV | Urology Physician (208800000X) |
United | Q4205 | $1159.60 | 1861571465 - MICHAEL FRANK SCHLAACK MD LTD, LEGACY URGENT CARE | 880191596 - (NV) MICHAEL F. SCHLAACK, MD, LTD. | NV | General Practice Physician (208D00000X) |
United | Q4205 | $1680.00 | 1629204235 - JENNIFER RHOADS | 1629204235 - (NV) JENNIFER RHOADS | NV | Anesthesiology Physician (207L00000X) |
United | Q4205 | $1680.00 | 1548249451 - LESA BROOKES | 1548249451 - (NV) LESA BROOKES | NV | Pediatrics Physician (208000000X) |
United | Q4205 | $1634.13 | 1962898759 - ALEXANDER LIN | 822026363 - WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS INC | NV | Radiation Oncology Physician (2085R0001X) |
United | Q4205 | $1310.44 | 1518907435 - ANDREW WELCH | 880180205 - (FL) WELCHS SOUTHWEST ORTHOPAEDICS & SPORTS MEDICINE CLINIC INC. | NV | Orthopaedic Surgery Physician (207X00000X) |
United | Q4205 | $1310.44 | 1336658921 - JAVIER RODRIGUEZ | 20566741 | NV | Family Medicine Physician (207Q00000X) |
United | Q4205 | $1159.60 | 1497259337 - BRITTNI USERA | 85130397 | NV | Radiation Oncology Physician (2085R0001X) |
United | Q4205 | $1159.60 | 1932437589 - ANDREW BADER | 471048138 - (NV) JEFFREY ZOLLINGER, DO PC | NV | Medical Physician Assistant (363AM0700X) |
United | Q4205 | $1310.44 | 1942253075 - DANIEL L. BURKHEAD, MD LTD, INNOVATIVE PAIN CARE CENTER | 880510658 - (NV) DANIEL L. BURKHEAD, M.D. LTD. DB | NV | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | Q4205 | $1159.60 | 1598104960 - OMAR ASHRAF | 300502262 | NV | Internal Medicine Physician (207R00000X) |
United | Q4205 | $1310.44 | 1336776046 - KARINA LUERA | 1336776046 - (NV) KARINA LUERA | NV | Family Medicine Physician (207Q00000X) |
United | Q4205 | $2555.37 | 1952714784 - GHAILA KENG | 800249057 - MOSES CONE PHYSICIAN SERVICES INC | NV | Internal Medicine Physician (207R00000X) |
United | Q4205 | $1159.60 | 1851701296 - MOHAMMAD HANIF | 882638571 - (CA) CRESCENT WOUND CARE INC | NV | Hospitalist Physician (208M00000X) |
United | Q4205 | $1310.44 | 1164434130 - CHARLES KRASNER | 880236758 | NV | Infectious Disease Physician (207RI0200X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS Q4205 vs. Other Skin Substitutes and Biologicals Codes
The HCPCS Q4205 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 Q4205 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 |
|---|---|---|
| Q4204-HCPCS | High | Xwrap, per square centimeter |
| Q4205-HCPCS | High | Membrane graft or membrane wrap, per square centimeter |
| Q4206-HCPCS | High | Fluid flow or fluid GF, 1 cc |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q4205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q4205 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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