HCPCS code Q4152 – DermaPure skin substitute

Key takeaways

HCPCS Code Q4152 describes DermaPure, a decellularized human dermal allograft from Tissue Regenix Wound Care, billed per square centimeter applied.

Q4152 is an add-on code. It is always reported with a primary skin substitute application code from CPT 15271-15278.

Since January 1, 2026, Medicare pays Q4152 as an incident-to supply at a flat national rate of $127.14 per square centimeter, adjusted by locality.

JW and JZ modifiers no longer apply, and quarterly ASP pricing is gone. Coverage still depends on your MAC’s policy.

Pabau is the practice management platform we build. Its claims management submits and tracks the claim through Claim.MD using the details your team has already recorded in the patient record.

HCPCS Code Q4152: definition and code descriptor

HCPCS Code Q4152 is assigned to DermaPure, a decellularized human dermal allograft made by Tissue Regenix Wound Care, and it is billed per square centimeter. The graft is donated human skin with the donor cells removed, leaving a dermal scaffold the patient’s own cells can grow into.

Q4152 is an add-on code, so it never stands alone on a claim. It is reported with the application procedure, such as CPT 15271 for the first 25 sq cm on the trunk, arms, or legs. The code has existed since 2015, and its current descriptor took effect on January 1, 2026.

The descriptor above comes from the CMS quarterly HCPCS update. Check the file for the quarter of the date of service before you submit, since CMS can revise Q-codes each quarter.

Why Q4152 must be billed with a primary application code

Q4152 pays for the graft, while the application code pays for the work of placing it. A claim that carries Q4152 without a 15271-15278 code on the same date is incomplete and will be denied.

The right primary code depends on the wound’s location and total area. Use this split to pick it:

• 15271 and 15272: trunk, arms, or legs, wound area up to 100 sq cm. 15271 covers the first 25 sq cm, and 15272 covers each additional 25 sq cm.
• 15273 and 15274: trunk, arms, or legs, wound area of 100 sq cm or more, or 1% of body area in infants and children.
• 15275 and 15276: face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, or multiple digits, wound area up to 100 sq cm.
• 15277 and 15278: the same high-visibility sites, wound area of 100 sq cm or more, or 1% of body area in infants and children.

The application codes count wound surface area, while Q4152 counts graft square centimeters. The two numbers often differ, so record both in the procedure note.

Clinical indications: which wounds qualify for Q4152

Medicare covers Q4152 for chronic wounds that have not healed with standard care, and the exact rules depend on the patient’s MAC. CMS withdrew the new skin substitute LCDs on December 24, 2025, before they took effect. Novitas, First Coast, and CGS kept their older skin substitute LCDs in force.

Palmetto GBA, NGS, WPS, and Noridian have no skin substitute LCD. Each claim in those jurisdictions is judged on whether the graft was reasonable and necessary. Wounds most often billed with Q4152 include:

• Diabetic foot ulcers (DFUs) that have not responded to at least four weeks of documented standard care
• Venous leg ulcers (VLUs) with documented failure of compression and standard wound care
• Other chronic wounds that meet the chronicity and non-response criteria in the applicable MAC policy

DermaPure is also used in surgical reconstruction, such as dehiscence or defects left after tumor removal. Medicare policy for those uses is narrower, so confirm coverage before applying the graft outside a chronic-wound setting. Cosmetic uses are not covered.

How to bill Q4152: units, quantity, and place of service

Every unit of Q4152 on the claim represents one square centimeter of DermaPure applied. Measure the wound’s length and width in centimeters, choose the graft size that covers it, and bill the square centimeters applied.

1. Measure the wound: length (cm) x width (cm) = wound area in sq cm
2. Record the wound area, graft size, lot number, and expiry date in the procedure note
3. Report the primary application code (15271-15278) for the wound area and site
4. Report Q4152 with the graft square centimeters applied as the unit count
5. Check that the units on the claim match the graft size in the note

The claim therefore carries two separate numbers, and the diagram below shows which code each one drives.

Entering those details once in the encounter record, then billing through claims management with tracking, removes the retyping step where most unit errors start.

Physician offices bill on the CMS-1500, and hospital outpatient departments bill on the UB-04. Place of service 11 (physician office) and 22 (outpatient hospital) are the usual settings, and the 2026 flat rate applies in both. Pull the place-of-service field from the encounter record rather than typing it on each claim.

Q4152 Medicare reimbursement rates in 2026

From January 1, 2026, Medicare pays Q4152 at a flat national rate of $127.14 per square centimeter. CMS’s CY2026 physician fee schedule final rule (CMS-1832-F) and the OPPS final rule reclassified skin substitutes as incident-to supplies. The change covers products in all three FDA pathways, including 361 HCT/P tissues such as DermaPure.

CMS first printed the rate as $127.28 and then corrected it to $127.14 in a November 28, 2025 correction notice. The rate is set for the full calendar year rather than updated quarterly. The fee schedule adjusts it by locality, and the OPPS adjusts it by the hospital wage index.

To look up your locality’s adjusted rate, search Q4152 in the CMS Physician Fee Schedule look-up tool. The application procedure is still paid separately from the graft. Because every qualifying skin substitute now earns the same rate, your margin on DermaPure depends on its purchase price.

Modifiers and discarded graft on Q4152 claims

JW and JZ modifiers no longer belong on Q4152 claims for 2026 dates of service. Those modifiers report waste from single-dose drugs and biologicals, and Q4152 is now paid as a supply. Appending them can trigger a modifier edit, often reported with CARC 4.

Bill only the square centimeters applied to the wound. Record any trimmed or unused graft in the procedure note, and follow your MAC’s instructions on discarded product. Commercial and Medicare Advantage plans may keep their own modifier rules, so check each contract.

ICD-10 diagnosis codes to pair with Q4152

Every Q4152 claim must carry ICD-10-CM codes that support a chronic wound covered by your MAC’s policy. Where Novitas, First Coast, or CGS is the MAC, the diagnosis must appear in that MAC’s billing article, such as A54117 for Novitas. Elsewhere, the codes must support medical necessity on review.

Check each pairing against your MAC’s policy in the Medicare Coverage Database for the date of service. Coders often trigger denials by using a broad parent code where the policy lists a more specific one. For a diabetic foot ulcer, our guide to E11.621 sets out how to pair it with the L97 site code.

Q4152 vs. similar skin substitute HCPCS codes

Each skin substitute Q-code is product-specific, so Q4152 can only be used for DermaPure. Since 2026 most of these codes pay the same flat rate, which removes any payment reason to pick one code over another. Billing the wrong code is still an improper claim.

Match the product name on the supplier invoice to the code’s descriptor before the claim goes out. When the invoice names any product other than DermaPure, Q4152 cannot be used. An AlloWrap invoice, for example, belongs on Q4150.

Flowerderm is a different human skin allograft, so its invoices bill under Q4179 rather than Q4152. Both are add-on codes billed per square centimeter, which makes the product name on the invoice the deciding detail.

Documentation requirements for Q4152 claims

A Q4152 claim holds up on review only when the record supported it before the application. A MAC reviewer expects to see these items in the file:

Keep these records against the encounter rather than in a separate purchasing file. A medical billing compliance protocol for skin substitutes should also set turnaround times for notes, invoices, and payer requests.

Common Q4152 claim denial reasons and how to resolve them

Most Q4152 denials follow a short list of patterns. The table below maps each one to the remittance code you are likely to see and the fix.

Look up any unfamiliar code in our guide to medical billing denial codes. Some denials need only a corrected claim, while others need a formal appeal. Medicare accepts a redetermination request within 120 days of the initial determination.

Tracking Q4152 denials by reason code over a quarter usually shows one or two upstream causes. Structured denial management workflows fix those causes in the documentation step, where they start.

Prior authorization and payer-specific rules for Q4152

Traditional Medicare does not usually require prior authorization for Q4152, and most claims are reviewed after payment. The exception is CMS’s WISeR model, which began in January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. There, skin substitutes need prior authorization only where an active skin substitute LCD applies. In practice that means New Jersey, Ohio, Oklahoma, and Texas, because Arizona and Washington have no active skin substitute LCD.

Medicare Advantage plans, Medicaid programs, and commercial payers set their own rules, and many require prior authorization. Run insurance eligibility verification before the first application with any of them:

• Check whether the payer requires prior authorization for Q4152 specifically
• Confirm the payer’s covered indications match the patient’s wound type and diagnosis
• Get the coverage decision in writing and keep it in the patient record
• Re-check authorization at each visit, since some payers approve a fixed number of applications

How claims management software supports accurate Q4152 billing

Most Q4152 errors happen when wound details move by hand from the procedure note to the claim. A coder retypes the graft size, looks up the lot number in a separate file, and forgets the primary application code.

Pabau, the practice management and billing platform we build, holds the wound measurement, the graft details, and the signed order against the encounter. Pabau’s claims management submits and tracks the claim through Claim.MD using the details your team has already recorded in the patient record. Supplier invoices and wound photographs can be stored against the same encounter.

Your team records the units and codes once, in the procedure note, and the claim goes out from that record rather than from memory. When a payer asks for records, the practice answers from one file instead of three.

Cut Q4152 denials with connected wound-care billing

Pabau’s claims management submits and tracks the claim through Claim.MD using the details your team has already recorded in the patient record. Supplier invoices stay with the encounter, so payer record requests take one file.

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Conclusion

The 2026 flat rate turned Q4152 from a pricing question into a documentation job. Medicare pays $127.14 per square centimeter of DermaPure, adjusted for locality, whatever the practice paid for the graft. The risk now sits in the claim itself. It needs a primary application code on the same date, units that match the graft, and a wound history your MAC accepts.

Start with the pairing, since an add-on code without its primary procedure fails every time. Then compare your adjusted rate with your DermaPure purchase price before the next order.

Pabau submits and tracks each claim through Claim.MD from the details already in the patient record, and it keeps supplier invoices with the encounter. Book a demo to see how Pabau keeps wound-care records and claim status in one place.

Continue your research

Billing the application procedure that goes with the graft? Our CPT 15271 guide covers the first 25 sq cm of skin substitute application on the trunk, arms, or legs.

Need to understand denial codes on your Q4152 remittance? Denial codes in medical billing explains the most common CARC and RARC codes and what each requires for appeal.

Comparing DermaPure with a living cell skin substitute? Our HCPCS Code Q4101 guide explains how Apligraf is coded and billed per square centimeter.

Want the end-to-end view of the revenue cycle? What is medical billing covers claim preparation through payment posting.

Grafting a wound larger than 25 sq cm on the trunk or legs? Our CPT 15272 guide explains how each additional 25 sq cm of skin substitute application is reported.

Frequently asked questions