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

Key Takeaways

HCPCS Code Q4107 describes Graftjacket (acellular dermal matrix), billed per square centimeter as an add-on code alongside a primary wound care procedure code

Q4107 is a temporary Q-series HCPCS Level II code maintained by CMS; it cannot be billed alone and must accompany a qualifying primary wound care code

Medicare coverage under LCD L30135 requires documented wound chronicity, failure of conservative treatment, and wound measurement at each visit before Q4107 claims are paid

Pabau’s claims management tools help wound care practices link Q4107 to the correct primary codes, calculate per-square-centimeter units, and maintain audit-ready documentation

Skin substitute claims are among the most scrutinized in Medicare wound care billing. Q4107 add-on claims for Graftjacket fail at a higher rate than primary wound care codes because coders miss the unit-calculation step, omit the required primary code pairing, or submit without the wound chronicity documentation that Medicare’s Local Coverage Determination requires. This reference covers the 2026 fee schedule, add-on billing rules, ICD-10 crosswalk, coverage criteria, and documentation checklist for HCPCS Code Q4107 so your claims are complete before submission.

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) to identify the application of the Graftjacket Regenerative Tissue Matrix skin substitute in a wound care encounter.

Graftjacket is an acellular dermal matrix derived from human dermis. The product undergoes processing to remove cellular material while preserving the extracellular collagen scaffold, which supports tissue regeneration. Because it is derived from human dermal tissue, it falls within the bioengineered skin and soft tissue substitute category covered under LCD L30135. Practices using claims management software can flag Q4107 as a product code requiring a paired primary wound care code to prevent standalone submission errors.

Clinical applications: when Q4107 is used

Graftjacket is applied to chronic wounds that have failed standard conservative treatment. The two primary indications covered under Medicare LCD L30135 are diabetic foot ulcers (DFU) and venous leg ulcers (VLU). Both conditions share the requirement for 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. Per LCD L30135 guidance, the wound must typically have been present for at least four weeks and failed standard wound care before Graftjacket application 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 application to pressure injuries at Stage III or IV where conservative measures have failed, though Medicare coverage for this indication varies by contractor. Verify with your specific Medicare Administrative Contractor (MAC) before billing.
• Surgical wounds with tissue deficit: Selected post-operative wounds requiring dermal reconstruction; coverage criteria are case-specific and typically require prior authorization outside routine wound care billing.

Wound care clinics managing these patient populations benefit from structured clinical documentation workflows that capture wound type, duration, and prior treatment history at every visit, since each of those data points feeds directly into the Q4107 coverage determination.

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

Q4107 add-on billing failures account for a significant proportion of skin substitute claim denials. The most common errors are submitting Q4107 without a primary code and calculating units incorrectly. The rules below follow AAPC HCPCS Level II coding guidance and CMS claims processing requirements.

Primary codes that must accompany Q4107

Q4107 cannot be billed as a standalone code. It must be reported 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: Wound(s), cleansing of a wound; without anesthesia, 6 cm² or larger
• 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 face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 cm²

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 document the measurement in the clinical record. Round to the nearest whole square centimeter. Overbilling units relative to 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 when Q4107 is billed on the same date as another skin substitute code for a different wound site to indicate a separate and distinct service.
• Modifier KX: Required by some MACs to indicate that the Medicare coverage criteria (wound chronicity, conservative treatment failure) have been met. Check your MAC’s LCD policy for applicability.
• Modifier GY: Item or service statutorily excluded. Use when billing a non-covered indication so Medicare generates an official denial for secondary payer purposes.

Practices running billing compliance workflows should build a pre-submission checklist that flags any Q4107 claim missing a primary code or unit entry before the 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. Because CMS updates PFS rates annually, the figures below reflect the 2026 schedule. Verify current rates using the CMS Physician Fee Schedule lookup tool for your specific geographic area, as Geographic Practice Cost Index (GPCI) adjustments apply by locality.

CMS does not publish a single national allowable for Q4107 because rates vary by locality. The research data available does not include verified 2026 per-cm² dollar figures, so avoid using third-party rate aggregators as your billing source of truth. Pull rates 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

Medicare covers Q4107 under LCD L30135 (Bioengineered Skin and Soft Tissue Substitutes). Coverage is conditional; the claim is payable only when the following criteria are met, per the LCD guidance currently active in your MAC’s jurisdiction. Always verify the current version of L30135, as LCDs are subject to revision.

• Wound type: Full-thickness diabetic foot ulcer or venous leg ulcer (or other wound type specified in the applicable contractor LCD).
• Wound duration: The wound has typically been present for at least four weeks prior to skin substitute application.
• Conservative treatment failure: Standard wound care (debridement, moisture-retentive dressings, off-loading for DFU, compression for VLU) has been attempted for a minimum duration without adequate healing response.
• Off-loading compliance (DFU): Documented evidence that the patient has 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. Progress toward healing must be tracked and documented.
• No active infection: The wound must be free of active infection at the time of application. Infected wounds require treatment of the infection before skin substitute application is appropriate.

Practices billing for wound care across multiple patient populations benefit from HIPAA-compliant clinical documentation tools that structure coverage criterion capture at the point of care rather than reconstructing it retrospectively for an audit.

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 documentation fields most commonly requested in post-payment audits.

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

ICD-10 codes commonly used with HCPCS Code Q4107

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

For DFU claims, the diabetic etiology code (E11.621 or E10.621) is sequenced first, with the wound site code (L97.4xx or L97.5xx) as a required secondary code. Submitting only the etiology code without the wound site is a common coding error that can trigger a request for additional information. Verify all codes against the current ICD-10-CM tabular list using the CMS annual 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 requires 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. Practices managing multiple skin substitute products should use a billing-integrated EHR system that links product selection at the clinical documentation step to the corresponding HCPCS code at the claim submission step, removing the manual lookup from the workflow.

How practice management software supports Q4107 billing

This is the section no code reference database covers. AAPC, FindACode, and similar lookup tools tell you what Q4107 means. They cannot tell you whether your clinic is applying it correctly across every patient encounter, catching unit calculation errors, or maintaining the wound documentation trail that survives a post-payment audit.

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

• Disconnected documentation and billing: The clinician records wound measurements in one system; the biller enters units manually in another. Transcription errors between those two steps are where unit mismatches originate. Integrated practice management platforms pass the wound area directly to the billing module, so the unit count matches what is documented every time.
• Missing primary code linkage: Add-on codes require a primary code on the same claim. When scheduling, documentation, and billing run in separate systems, the primary code is sometimes omitted at submission. Rules-based claim scrubbing in integrated claims management software flags an orphan Q4107 before it reaches the payer.
• Incomplete longitudinal wound records: A single clean note at the application visit is rarely enough. Payers reviewing Q4107 claims in a post-payment audit want to see wound measurements across multiple preceding visits, conservative treatment notes, and off-loading or compression compliance documentation. A platform with structured wound note templates, like those within Pabau’s digital forms module, captures all of that at each encounter without requiring the clinician to remember every required field.

Wound care practices billing significant volumes of Q-series skin substitute codes benefit from skin clinic software that connects clinical documentation, billing rules, and audit-readiness in a single platform. For dermatology and wound care settings specifically, dermatology EMR software with built-in wound tracking removes the documentation gaps that generate most skin substitute denials.

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 maintain the longitudinal wound records Medicare auditors expect.

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Q4107 code history and 2026 status

Q4107 is an active HCPCS Level II code as of the 2026 code year. CMS maintains the Q4100 series of skin substitute codes and updates them through the annual HCPCS Level II update process. Verify the current effective status of Q4107 using the CMS HCPCS overview and annual code files or through an HCPCS lookup tool that mirrors the official CMS data.

Because Q-series codes are temporary by design, practices should run an annual code review at the start of each fiscal year to confirm that Q4107 and any other Q-series skin substitute codes in use remain active and unchanged. A code that has been deleted or reassigned mid-year creates claim rejections that can take weeks to resolve. The best EMR software for wound care settings supports annual code library updates so your billing team does not rely on memory to catch retired codes.

Conclusion

Q4107 claims fail most often for three reasons: no primary code on the claim, unit counts that do not match the documented wound area, and conservative treatment records that cannot support a medical necessity determination. The code rules and documentation standards above address all three. For practices billing Q-series skin substitute codes at volume, the real compliance challenge is not knowing the rules; it is applying them consistently across every encounter without manual errors.

Pabau’s integrated documentation and practice management platform connects wound measurement, clinical notes, and claim scrubbing so Q4107 billing is accurate from the point of care through submission. To see how Pabau handles skin substitute billing workflows, book a demo.

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