Q4205 — Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)
Q4205 is a HCPCS Level II code for membrane graft or membrane wrap, 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 Q4205
- Long descriptor
- Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Short descriptor
- Membrane graft or wrap sq cm
- Added
- October 1, 2019
- 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 Q4205
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q4205 is not quite right, the correct code is very often within a few positions of it.
- Q4197Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4198Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4199Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4200Skin te, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4201Matrion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4202Keroxx (2.5g/cc), 1cc
- Q4203Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4204Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4206Fluid flow or fluid gf, 1 cc
- Q4208Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)
- Q4209Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4210Axolotl graft or axolotl dualgraft, per square centimeterterminated
- Q4211Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4212Allogen, per cc
- Q4213Ascent, 0.5 mg
- Q4214Cellesta cord, per square centimeter (add-on, list separately in addition to primary procedure)
Questions about Q4205
What is HCPCS code Q4205?
Q4205 is a HCPCS Level II code for membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure). It sits in the Temporary Codes section.
Does Medicare cover Q4205?
The CMS HCPCS file marks Q4205 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 Q4205 paid under the physician fee schedule?
Q4205 carries PFS status code A. Active code. Paid separately under the physician fee schedule.