HCPCS Code Q4107: Graftjacket billing, fee schedule and Medicare coverage

Key takeaways

HCPCS Code Q4107 describes Graftjacket, an acellular dermal matrix billed per square centimeter of graft applied.

Q4107 is a temporary Q-series HCPCS Level II code maintained by CMS, and it cannot be submitted on its own.

Medicare coverage for Q4107 is set by each Medicare Administrative Contractor, not by a single national or numbered LCD.

Payers still expect documented wound chronicity, failed conservative treatment, and wound measurements recorded at every visit.

Pabau links Q4107 to the correct primary codes, calculates per-square-centimeter units, and keeps the wound record audit-ready.

HCPCS Code Q4107 is the billing code for Graftjacket, an acellular dermal matrix applied to chronic wounds. It is reported per square centimeter of graft used, and only alongside a primary wound care procedure code. This reference covers the 2026 fee schedule, add-on billing rules, the ICD-10 crosswalk, current Medicare coverage, and the documentation payers ask for.

One thing has changed for 2026. Skin substitute coverage is no longer anchored to a single long-standing Local Coverage Determination. The policy that decides your claim now depends on your Medicare Administrative Contractor (MAC).

HCPCS Code Q4107: code description and key details

HCPCS Code Q4107 describes Graftjacket, per square centimeter. It is a temporary HCPCS Level II Q-series code assigned and maintained by the Centers for Medicare and Medicaid Services (CMS). The code identifies the application of Graftjacket Regenerative Tissue Matrix during a wound care encounter.

Graftjacket is an acellular dermal matrix derived from human dermis. Processing removes the cellular material while preserving the extracellular collagen scaffold that supports tissue regeneration. Because it comes from human dermal tissue, it sits in the bioengineered skin and soft tissue substitute category that payers review most closely. Practices using claims management software can flag Q4107 as a product code that needs a paired primary code, which prevents standalone submission.

Clinical applications: when Q4107 is used

Graftjacket is applied to chronic wounds that have failed standard conservative treatment. The two indications payers cover most consistently are diabetic foot ulcers (DFU) and venous leg ulcers (VLU). Both require documented wound chronicity before a skin substitute claim is payable.

• Diabetic foot ulcers (DFU): Full-thickness wounds on the plantar or dorsal surface of the foot in patients with diabetes. Most contractor policies expect the wound to have been present for at least four weeks. Standard wound care must also have been tried and failed before Graftjacket is covered.
• Venous leg ulcers (VLU): Wounds of venous origin on the lower leg. Standard care failure documentation must accompany the claim, including evidence of compression therapy compliance.
• Pressure injuries (limited coverage): Some payers cover Graftjacket for Stage III or IV pressure injuries where conservative measures have failed. Medicare coverage for this indication varies by contractor, so verify with your MAC before billing.
• Surgical wounds with tissue deficit: Selected post-operative wounds that need dermal reconstruction. Coverage is case-specific and often requires prior authorization outside routine wound care billing.

Wound care practices managing these patient populations benefit from structured clinical documentation workflows that capture wound type, duration, and prior treatment at every visit. Each of those data points feeds the Q4107 coverage decision.

How to bill Q4107: add-on code rules and billing guidelines

Two mistakes drive most Q4107 rejections. The code is submitted without a primary procedure, or the unit count is calculated incorrectly. The rules below follow AAPC coding guidance and CMS claims processing requirements.

Primary codes that must accompany Q4107

Q4107 cannot be billed as a standalone code. It must appear on the same claim as a qualifying primary wound care procedure code. Commonly paired primary codes include:

• 97597: Debridement, open wound; first 20 cm² or less
• 97598: Debridement, open wound; each additional 20 cm² (add-on to 97597)
• 97602: Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia, per session
• 15271: Application of skin substitute graft to trunk, arms, or legs; first 25 cm²
• 15272: Application of skin substitute graft; each additional 25 cm² (add-on to 15271)
• 15273: Application of skin substitute graft to trunk, arms, or legs, total wound area 100 cm² or greater; first 100 cm²
• 15275: Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits; first 25 cm²

Surgical preparation of the wound bed is reported separately. When the provider excises or debrides the site to receive the graft, that work is coded on its own. Use the 15002 to 15005 range rather than folding it into the application code.

Unit calculation: per square centimeter

Bill one unit of Q4107 for each square centimeter of Graftjacket applied. Measure the wound surface area at the time of application and record it in the clinical note. Round to the nearest whole square centimeter. Overbilling units relative to the documented wound size is a common audit trigger.

Example: A wound measures 4 cm x 3 cm (12 cm²). Bill Q4107 x 12 units alongside the appropriate primary application code.

Modifier usage

• Modifier 59: Distinct procedural service. Use it when Q4107 is billed on the same date as another skin substitute code for a different wound site.
• Modifier KX: Required by some MACs to confirm that the coverage criteria have been met. Check your contractor’s current policy before appending it.
• Modifier GY: Item or service statutorily excluded. Use it when billing a non-covered indication, so Medicare issues a formal denial for the secondary payer.

Practices that run regular medical chart audits should build a pre-submission checklist. It flags any Q4107 claim missing a primary code or a unit entry before that claim reaches the clearinghouse.

Q4107 fee schedule 2026: Medicare reimbursement rates

Medicare Part B reimburses Q4107 per square centimeter under the Physician Fee Schedule (PFS). Rates differ between facility and non-facility settings, and CMS updates them every year. Check current rates with the CMS fee schedule lookup for your locality, since Geographic Practice Cost Index (GPCI) adjustments apply.

CMS does not publish a single national allowable for Q4107, because rates vary by locality. Third-party rate aggregators list per-cm² figures, but those are estimates rather than your contractor’s allowable. Pull the rate directly from the CMS PFS search tool using your practice’s locality code. Commercial payer rates are set by contract and are not bound by the Medicare PFS.

Medicare coverage criteria for Q4107

Q4107 coverage is decided by your Medicare Administrative Contractor, not by a single national or numbered Local Coverage Determination. CMS and the MACs finalized a unified set of skin substitute LCDs with an effective date of January 1, 2026. Several contractors then withdrew those policies on December 24, 2025.

That leaves coverage in a number of jurisdictions determined case by case, under the standard reasonable and necessary review. Before you bill, check the currently active LCD or billing and coding article for your contractor in the CMS Medicare Coverage Database. Contractor policies differ in wording, but the clinical criteria below are the ones payers look for consistently.

• Wound type: Full-thickness diabetic foot ulcer or venous leg ulcer, or another wound type named in your contractor’s active policy.
• Wound duration: The wound has typically been present for at least four weeks before skin substitute application.
• Conservative treatment failure: Standard wound care has been tried without an adequate healing response. That includes debridement such as 11042, moisture-retentive dressings, off-loading for DFU, and compression for VLU.
• Off-loading compliance (DFU): Documented evidence that the patient used appropriate off-loading during the conservative treatment period.
• Compression compliance (VLU): Documented evidence of compression therapy before and during skin substitute application.
• Wound measurements: Wound length, width, and depth recorded at each visit, with progress toward healing tracked over time.
• No active infection: The wound must be free of active infection at the time of application. Treat the infection first.

Practices billing wound care across multiple patient populations benefit from HIPAA-compliant documentation tools that capture each coverage criterion at the point of care. Reconstructing that record during an audit takes far longer and often falls short.

Documentation requirements for Q4107 claims

Missing or inadequate documentation is the leading cause of Q4107 denial and recoupment. Medicare and most commercial payers expect the clinical record to demonstrate medical necessity at the time of each application. The checklist below reflects the fields most commonly requested in post-payment audits.

Structured wound care note templates in digital clinical forms pre-populate the measurement fields and prompt for conservative treatment entries. They also flag incomplete notes before those notes reach billing. Practices using wound measurement tracking produce a longitudinal wound area trend, which satisfies the healing-trajectory documentation payers request during audits.

ICD-10 codes commonly billed with Q4107

The ICD-10-CM diagnosis codes submitted with Q4107 must match the covered wound type and be supported by the clinical record. The table below lists the codes most often paired with Q4107, organized by wound category. Use the most specific code available, including laterality and severity where the tabular list requires it.

For DFU claims, sequence the diabetic etiology code (E11.621 or E10.621) first. The wound site code (L97.4xx or L97.5xx) is a required secondary code. Submitting the etiology code alone is a common error that triggers a request for additional information. Verify every code against the current CMS ICD-10-CM code list for the applicable fiscal year.

Related HCPCS codes: Q4100 series skin substitute codes

Q4107 belongs to the Q4100 series of temporary HCPCS codes assigned by CMS to identify individual skin substitute products. Each code in the series identifies a specific product billed per square centimeter. Selecting the correct code means matching the product actually applied to the patient. The codes are not interchangeable.

Using the wrong Q-code for the product applied is an upcoding or downcoding error with audit and recoupment consequences. Graftjacket Xpress, the injectable flowable form, is a separate product with its own code, Q4113, billed per cubic centimeter. Practices managing several skin substitute products should use a billing-integrated EHR that links product selection at documentation to the matching HCPCS code at submission.

Q4107 code history and 2026 status

Q4107 is an active HCPCS Level II code for the 2026 code year. CMS maintains the Q4100 series and revises it through the annual HCPCS Level II update process. Confirm the current status of Q4107 against the CMS HCPCS annual code file before your first claim of the year.

Because Q-series codes are temporary by design, run a code review at the start of each fiscal year. Confirm that Q4107 and every other Q-series skin substitute code you use is still active and unchanged. A code deleted or reassigned mid-year creates rejections that take weeks to resolve. The best EMR software for wound care supports annual code library updates, so your billing team is not relying on memory.

How practice management software supports Q4107 billing

Code lookup tools tell you what Q4107 means. They cannot tell you whether your practice applies it consistently, catches unit errors, and keeps the wound record that survives a post-payment audit.

Three workflow problems drive most Q4107 billing errors in wound care practices:

• Disconnected documentation and billing: The clinician records wound measurements in one system, and the biller enters units by hand in another. Transcription between those two steps is where unit mismatches start. Practice management software like Pabau passes the wound area straight to the billing module, so the unit count matches the note every time.
• Missing primary code linkage: Add-on codes need a primary code on the same claim. When scheduling, documentation, and billing sit in separate systems, that primary code is sometimes dropped at submission. Rules-based claim scrubbing flags an orphan Q4107 before it reaches the payer.
• Incomplete longitudinal wound records: One clean note at the application visit is rarely enough. Payers reviewing a Q4107 claim want measurements from several preceding visits, conservative treatment notes, and off-loading or compression records. Pabau’s digital forms capture all of it at each encounter, without asking the clinician to remember every required field.

Wound care practices billing Q-series codes at volume benefit from skin clinic software that connects documentation, billing rules, and audit readiness. For dermatology and wound care settings.

Related HCPCS codes

• HCPCS code Q9966 — Low Osmolar Contrast Material
• HCPCS code Q4131 — Epifix or Epicord, now Q4186/Q4187
• HCPCS code Q4205 — Membrane Graft or Wrap
• HCPCS Code Q5101 — Zarxio billing, reimbursement, and modifiers

Reduce skin substitute billing errors with integrated documentation

Pabau connects wound measurement, clinical notes, and billing in one platform. Link Q4107 add-on codes to primary procedures, auto-populate unit counts from documented wound area, and keep the longitudinal wound records Medicare auditors expect.

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Conclusion

Treat Q4107 as a documentation code first and a billing code second. The unit count, the primary code pairing, and the wound history all come from the clinical note. A weak note guarantees a weak claim.

Coverage is the part worth rechecking this year. With the unified skin substitute LCDs withdrawn in several jurisdictions, your contractor’s active policy is the only answer that counts. Build that check into your annual code review rather than trusting a policy number you have used for years.

Pabau’s integrated documentation and practice management platform connects wound measurement, clinical notes, and claim scrubbing. Q4107 billing then stays accurate from the exam room through to submission. Book a demo to see how it handles skin substitute claims.

Continue your research

Grafting the face, hands, or feet? 15276 covers the additional-area units for skin substitute application at those sites.

Debriding down to bone before the graft? 11044 sets out how deep debridement is documented and billed at the same encounter.

Treating a necrotizing soft tissue infection? 11005 covers abdominal wall debridement and the documentation payers expect with it.

Closing a wound with tissue adhesive instead? G0168 explains when adhesive-only wound closure is billable and how to record it.

Coding a traumatic open wound rather than a chronic ulcer? S41.021A shows how laceration diagnoses are specified for laterality and encounter type.

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