Q4104 — Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
Q4104 is a HCPCS Level II code for integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure). It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 0.00
- PE (non-facility)
- 3.81
- PE (facility)
- 3.81
- Malpractice RVU
- 0.00
Global period: ZZZ
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The CMS record for Q4104
- Long descriptor
- Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
- Short descriptor
- Integra bmwd
- Added
- January 1, 2009
- BETOS
- O1E
- Pricing indicator
- 11 — Physician fee schedule
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Price established using national RVUs.
Codes adjacent to Q4104
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q4104 is not quite right, the correct code is very often within a few positions of it.
- Q4051Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)
- Q4074Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms
- Q4081Injection, epoetin alfa, 100 units (for esrd on dialysis)
- Q4082Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)
- Q4100Skin substitute, not otherwise specifiedterminated
- Q4101Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4102Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4103Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4105Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4106Dermagraft, per square centimeterterminated
- Q4107Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4108Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4110Primatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4111Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4112Cymetra, injectable, 1 cc
- Q4113Graftjacket xpress, injectable, 1 cc
Questions about Q4104
What is HCPCS code Q4104?
Q4104 is a HCPCS Level II code for integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure). It sits in the Temporary Codes section.
Does Medicare cover Q4104?
The CMS HCPCS file marks Q4104 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is Q4104 paid under the physician fee schedule?
Q4104 carries PFS status code A. Active code. Paid separately under the physician fee schedule.