HCPCS code Q4106 is deleted: Dermagraft billing status for 2026

Key takeaways

HCPCS code Q4106 (Dermagraft, per square centimeter) was deleted effective December 31, 2025, and is not billable for 2026 dates of service

The CMS January 2026 HCPCS file still lists Q4106, but the record carries action code D and a termination date of 20251231

Dermagraft has not been sold since the second quarter of 2022, and Organogenesis has delayed the relaunch with no projected timing

For CY 2026, CMS pays a single national rate of $127.14 per square centimeter for skin substitute products in three new APCs

The high-cost and low-cost skin substitute split is gone, and the low-cost application codes C5271 through C5278 were deleted

Practice management software like Pabau keeps code libraries, wound documentation, and claim submission in one workflow, so retired codes stop reaching payers

Is HCPCS code Q4106 still billable in 2026?

No. HCPCS code Q4106 (Dermagraft, per square centimeter) was deleted effective December 31, 2025. It cannot be billed for any date of service on or after January 1, 2026.

The confusion is easy to understand, because the code has not disappeared from the reference files. Q4106 still appears in the CMS January 2026 Alpha-Numeric HCPCS file, which is why plenty of lookup tools still return a result for it. Read the record itself, though, and the answer is unambiguous.

In that file, the Q4106 record carries action code D, which the CMS record layout defines as “discontinue procedure or modifier code”. The termination date field reads 20251231, and the action effective date reads 20260101. The accompanying CMS transaction report lists Q4106 with a single word in the action column: Discontinued.

You can check this yourself in about two minutes. Download the current quarterly file from the CMS HCPCS quarterly update page, open the fixed-width text file, and find the line starting Q4106. Characters 285 to 292 hold the termination date. A third-party code lookup will not always show you that field.

Why CMS deleted Q4106

Q4106 was retired because the product behind it is no longer on the market. The wider 2026 skin substitute payment reform did not sweep it away. That distinction matters when you audit the rest of your Q-code list.

Organogenesis has disclosed the Dermagraft timeline in its SEC filings for several years. Manufacturing was suspended in the fourth quarter of 2021. Sales were suspended in the second quarter of 2022. The company planned to restart production at a new biomanufacturing facility in Smithfield, Rhode Island and resume sales by the end of 2027.

That plan has since slipped. Organogenesis said in its quarterly report for the period ended June 30, 2026 that the relaunch is delayed. The filing adds that the company “cannot currently project specific timing”. So there is no billable product, and as of January 1, 2026, no billable code.

Laid out in order, the sequence shows the product leaving the market years before the code did.

The scale of the deletion is worth seeing, because it is smaller than most billing commentary suggests. The January 2026 HCPCS annual update touched 369 codes in the Q4000 series. Only two of them were discontinued.

Counts are taken from the CMS January 2026 HCPCS transaction report. The practical reading is simple. If a Q-code in your chargemaster stopped working in January, a deletion is only likely if the product itself left the market.

What to do if Q4106 is still in your chargemaster

Retire the code rather than remap it. There is no successor product code for Dermagraft, so a substitute code would describe a different product than the one your clinician applied. Work through these steps in order.

• End-date the chargemaster entry at December 31, 2025. Do not delete the row outright, because you still need it to price and defend older claims.
• Close out open 2025 claims first. Dates of service on or before December 31, 2025 remain billable within your payer’s timely filing window.
• Block new charges. Add a hard stop so Q4106 cannot be selected for a 2026 encounter, rather than relying on a coder to remember.
• Re-check any claim rejected in January or February. A rejection on an invalid code often gets rebilled unchanged, which simply produces a second rejection.
• Confirm which product the clinician applied. Practices sometimes keep billing a familiar Q-code after switching products, and that is a compliance problem rather than a coding shortcut.
• Update your denial rules. Route any future invalid-code rejection to a person who can check the CMS file, not back into the same resubmission queue.

Practices with a structured denial management process usually catch a retired code within a week. Practices without one tend to discover it during a quarterly reconciliation, several cycles of lost revenue later.

How Medicare pays for skin substitutes in 2026

CMS now pays one national rate of $127.14 per square centimeter for skin substitute products, regardless of which product was applied. The rate was set in the CY 2026 OPPS and ASC final rule, published on November 25, 2025.

Two changes landed at once. Products are now paid separately from the procedure that applies them, rather than being packaged into it. And they are grouped by FDA regulatory pathway instead of by average sales price, using three new ambulatory payment classifications.

All three APCs pay the same amount for CY 2026. CMS created a new status indicator, S1, to mark skin substitute products that are paid separately under the OPPS. Every product assigned to APC 6000, 6001 or 6002 carries that indicator.

The framework applies in the physician office (non-facility) setting, the hospital outpatient department, and the ambulatory surgical center. CMS said it will update the category rates annually through rulemaking, using the most recent quarter of average sales price data where that data exists.

The high-cost and low-cost split no longer exists

CMS eliminated the high-cost and low-cost skin substitute categories for CY 2026. If your billing protocol still asks a coder to check a product’s cost tier, drop that step. It is obsolete now, and it only introduces errors.

The low-cost application codes C5271 through C5278 were deleted in the same rule. CPT codes 15271 through 15278 remain, and they now describe skin substitute application for every product rather than only the high-cost group. The add-on codes 15272, 15274, 15276 and 15278 stay packaged in the hospital outpatient setting.

Skin substitute product codes are now add-on codes

CMS converted the surviving skin substitute product codes into add-on codes so that a product can never be billed without an application procedure. In the January 2026 file, 270 Q4000-series descriptors carry add-on wording that did not appear a quarter earlier.

Q4107 is a good example of the pattern. Its 2025 descriptor read “Graftjacket, per square centimeter”. The 2026 descriptor reads “Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)”. The code number did not move, so a chargemaster comparison based on code numbers alone will miss the change entirely.

Three unlisted codes were added for products that have FDA authorization but no product-specific code yet. Q4431 covers PMA products, Q4432 covers 510(k) products, and Q4433 covers 361 HCT/P products. Each maps to the matching APC.

ICD-10 diagnosis codes that support a skin substitute claim

Every skin substitute claim must link to an ICD-10-CM diagnosis that establishes medical necessity. The payment reform did not loosen this. The wound type recorded in the chart has to match the diagnosis on the claim.

Always pick the most specific code available. Billing L98.499 for a wound the chart clearly describes as a diabetic foot ulcer is a familiar route to a medical necessity denial. Check the covered diagnosis list in your MAC’s local coverage determination before you submit. If you need the detail behind one of these diagnoses, our ICD-10-CM code reference covers each code on its own page.

Medicare coverage and prior authorization requirements

Coverage for a skin substitute application is decided by your MAC’s local coverage determination, not by the payment rule. Search the Medicare Coverage Database for the LCD and billing article that apply in your jurisdiction, and read them before the first application. Coverage is not automatic.

Criteria differ by contractor, but most LCDs in this category expect the following:

• The wound has been present for at least four weeks despite appropriate conventional care
• Failed conservative therapy is documented, typically compression for venous ulcers and offloading for diabetic foot ulcers
• Wound infection has been ruled out or treated before the application
• Wound size is measured and recorded at every visit using a consistent method
• The wound type matches a covered ICD-10-CM diagnosis in the applicable LCD
• The wound does not involve exposed bone, tendon, or joint capsule, unless the LCD says otherwise

Prior authorization: Original Medicare does not universally require prior authorization for skin substitute applications, but many Medicare Advantage plans do. Requirements also vary by MAC jurisdiction. Check the individual plan before the appointment, because an application performed without a required authorization is rarely recoverable on appeal.

One more caution for 2026. Several MACs withdrew or revised their skin substitute LCDs around the payment change. A policy your team saved as a PDF last year may no longer be in force. Re-pull the current version rather than working from a local copy.

Documentation requirements for skin substitute claims

Incomplete documentation drives more skin substitute denials than coding errors do. A wound care note works as a clinical record and as a billing defense document at the same time. Capturing the required fields at the point of care is far easier than reconstructing them during an audit.

Record the following at every application encounter:

• Wound measurements: Length, width, and depth in centimeters, with the surface area used to calculate the billed units
• Wound type and etiology: A clinical description that matches the ICD-10-CM code on the claim
• Wound duration: An explicit note that the wound has been present for at least four weeks
• Conservative therapy: What was tried before, how long for, and how the wound responded
• Product identity: Product name, size, and lot or batch number, so the billed code matches what was applied
• Application number: First or subsequent application, which drives the application CPT code you select
• Wound photograph: Increasingly expected by MACs as audit support
• Progress note: The clinician’s assessment of response, supporting continued treatment

The product identity line matters more in 2026 than it did before. With every product paying the same rate, the code you submit no longer changes the payment. It still has to describe the item on the shelf. Meeting those documentation requirements from the first encounter keeps the record defensible.

Common skin substitute billing errors in 2026

Most avoidable rejections this year come from protocols written for the old rules. The table below covers the errors that surface most often after the January 2026 change.

When a claim is denied, pull the remittance advice remark code and the claim adjustment reason code. Together they name the specific problem and point at the fix. An invalid-code rejection is a chargemaster job, not a resubmission job.

How Pabau supports wound care and skin substitute billing

A retired code costs money for as long as it stays in the system. Q4106 is the obvious example. The same pattern repeats every January, when descriptors change and nobody reconciles the chargemaster against the current CMS file.

Practice management software like Pabau keeps the clinical note, the code library, and the claim in one place. When a code is retired, you change it once, and the change reaches every future charge. No spreadsheet has to be circulated for it to take effect. Pabau’s claims management software handles that path end to end.

For wound care teams and dermatology practices billing Q-codes, that means:

• Structured wound documentation: Templates capture measurements, wound type, application number, and product lot at the visit. The note then already contains what the payer will ask for
• A maintained code library: Product and application codes sit together, so a retired entry is corrected once rather than in each coder’s habit
• Electronic claim submission: Claims go out from the encounter itself, which removes the re-keying step where wrong codes usually creep in
• Denial tracking: Each denial links back to the encounter that produced it, so you can see whether one code is driving a pattern

The outcome practices notice first is how quickly a CMS change reaches a clean claim. See how it fits your wound care workflow, or book a demo to walk through it with our team.

Keep retired codes out of your claims

Pabau connects wound documentation, your code library, and claim submission in one workflow, so a code change reaches every future charge. See how it works for your practice.

Book a demo

Conclusion

Q4106 is a historical code. It described Dermagraft, per square centimeter, and it terminated on December 31, 2025. It should now appear only on closed 2025 claims and in your archive. Any 2026 charge against it will be rejected.

The wider change is the bigger workload. Skin substitute products are paid separately at one national rate of $127.14 per square centimeter. The cost tiers are gone, and product codes now behave as add-on codes. Practices that rewrite their protocol around those three facts will spend far less of 2026 reworking rejections.

If your chargemaster is still carrying codes that CMS retired in January, that is a workflow problem rather than a coding one. Book a demo to see how Pabau keeps documentation, coding, and claims moving together.

Continue your research

Need a complete framework for medical billing workflows? What is medical billing covers the end-to-end billing cycle, from charge capture to payment posting, in plain language for practice teams.

Want to reduce claim denials across your practice? Denial management in healthcare explains how to categorize, track, and systematically reduce denial rates for complex procedure codes.

Still closing out 2025 dates of service? Timely filing limits sets out how long each payer gives you to submit a claim before the revenue is written off.

Need to tighten prior authorization before the visit? The prior authorization process walks through the steps that stop a Medicare Advantage approval from arriving after the appointment.

Frequently asked questions