Q4269 — Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure)
Q4269 is a HCPCS Level II code for surgraft xt, 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for Q4269
- Long descriptor
- Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure)
- Short descriptor
- Surgraft xt per sq cm
- Added
- April 1, 2023
- 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 Q4269
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q4269 is not quite right, the correct code is very often within a few positions of it.
- Q4261Tag, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4262Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4263Surgraft tl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4264Cocoon membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4265Neostim tl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4266Neostim membrane, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4267Neostim dl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4268Surgraft ft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4270Complete sl, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4271Complete ft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4272Esano a, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4273Esano aaa, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4274Esano ac, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4275Esano aca, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4276Orion, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4277Woundplus membrane or e-graft, per square centimeterterminated
Questions about Q4269
What is HCPCS code Q4269?
Q4269 is a HCPCS Level II code for surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure). It sits in the Temporary Codes section.
Does Medicare cover Q4269?
The CMS HCPCS file marks Q4269 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 Q4269 paid under the physician fee schedule?
Q4269 carries PFS status code A. Active code. Paid separately under the physician fee schedule.