HCPCS code Q4195 – PuraPly, per square centimeter

Key takeaways

HCPCS Code Q4195 bills PuraPly, an Organogenesis collagen wound matrix, per square centimeter as an add-on to a skin substitute application code.

Q4172 is deleted. It covered PuraPly and PuraPly AM in 2017 and 2018, and from January 1, 2019 PuraPly takes Q4195 while PuraPly AM takes Q4196.

In 2026 Medicare pays PuraPly as an incident-to supply at a flat national rate of $127.14 per square centimeter, with no payment for discarded product.

Wound site and total wound area pick the application code from 15271 to 15278, and only the square centimeters applied are billed.

Coverage turns on your contractor, because only Novitas, CGS and First Coast still run a skin substitute LCD.

HCPCS Code Q4195: Definition, product and code status

HCPCS Code Q4195 is the Level II code for PuraPly, per square centimeter.

It is an add-on code, so it is always listed in addition to a primary skin substitute application procedure.

PuraPly is a porcine collagen wound matrix made by Organogenesis and cleared by the FDA as a 510(k) medical device. Q4195 identifies the product applied, while a separate CPT code reports the application itself.

The descriptor names one product only. Using Q4195 for PuraPly AM, PuraPly XT or another collagen matrix is a coding error, even when the products sit on the same shelf.

Q4172 was the deleted predecessor of Q4195

Q4172 is no longer a valid HCPCS code. Its descriptor read “Puraply or puraply am, per square centimeter,” and it covered both products under one code from January 1, 2017.

CMS terminated Q4172 on December 31, 2018. On January 1, 2019 it split the code in two, giving PuraPly Q4195 and PuraPly AM its own code, Q4196.

Q4172 had a predecessor of its own. C9349, a hospital outpatient code for PuraPly and PuraPly antimicrobial, ran from 2015 until CMS deleted it at the end of 2016.

A claim that still carries Q4172 for a current date of service is rejected as an invalid code. Search your charge master, superbill templates and saved claim templates for Q4172, then replace it with Q4195 or Q4196.

2026 Medicare payment for HCPCS Code Q4195

Medicare pays Q4195 at a flat national rate of $127.14 per square centimeter in 2026. The rate comes from the CY2026 Physician Fee Schedule final rule, CMS-1832-F, effective January 1, 2026.

That rule moved skin substitutes that are not licensed as biologics out of drug pricing. They are now paid as incident-to supplies when used with a covered application procedure.

PuraPly is a 510(k)-cleared device, not a biologic, so it falls under the flat rate. Products licensed under a biologics license application (BLA) are excluded from it.

A 9 cm² application of PuraPly bills 9 units of Q4195. At the national rate that is $1,144.26 for the product, before your locality adjustment.

The application CPT code is paid on its own line. Check your locality in the CMS Physician Fee Schedule lookup before you quote a figure.

Who bills Q4195 in each place of service

The place of service decides who reports the product. In a physician office the practice bills both lines, but in a facility the physician bills only the application.

In POS 19, 22 and 24 the physician’s claim carries the application CPT code alone. Adding Q4195 to the professional claim in a facility duplicates the product charge and can be denied.

POS 23 is a hospital emergency room, not an outpatient wound care department. A skin substitute claim sent with POS 23 by mistake can come back with CARC 5.

How to bill HCPCS Code Q4195 with an application code

Bill Q4195 on its own line under a primary CPT application code from the 15271–15278 family. Two facts pick that code, which are the wound’s location and its total surface area.

A foot ulcer takes 15275 rather than 15271, because the foot sits in the second site group. A 30 cm² foot ulcer bills 15275 once and 15276 once, plus 30 units of Q4195.

Our guide to CPT code 15271 covers the full descriptor and bundling notes for the trunk, arm and leg family.

Units of service and product sizing

One unit of Q4195 equals one square centimeter of PuraPly applied to the wound. Record the area in the note, then bill that number of units.

Organogenesis supplies PuraPly in several sheet sizes for single use. Its coding guide says the code counts product size, but Medicare stopped paying for discarded supply on January 1, 2026.

For Medicare, bill only what was placed on the wound. If a 16 cm² sheet is opened and 11 cm² is applied, the claim carries 11 units, and the practice absorbs the rest.

That makes sheet selection a cost decision. Choose the smallest size that covers the measured wound, and record the size opened next to the area applied.

Modifiers on Q4195 claims

A modifier that does not fit the code returns CARC 4, which means the procedure code is inconsistent with the modifier used.

Medicare coverage and prior authorization for Q4195

Medicare covers Q4195 when the record shows a chronic wound that failed standard care and meets the reasonable-and-necessary standard. Which written policy applies depends on your Medicare contractor.

Only three A/B MACs still enforce a legacy skin substitute LCD. They are Novitas Solutions (L35041), CGS Administrators (L36690) and First Coast Service Options.

The new unified skin substitute LCDs, due on January 1, 2026, were withdrawn on December 24, 2025. Every other MAC now reviews PuraPly claims case by case, without a published LCD.

The WISeR model also runs in Arizona and Washington. Skin substitutes are not on its list there, because those states have no active skin substitute LCD.

Build a medical billing compliance check that confirms your contractor’s current position before the date of service, not after the denial.

ICD-10-CM codes that support a Q4195 claim

The diagnosis has to show a chronic ulcer and its cause. Code the underlying condition first, then the ulcer code that gives the site and depth. A diabetic foot ulcer in a type 2 patient, for example, starts with E11.621 and adds an L97.4- or L97.5- code.

Avoid unspecified codes when the chart records site and depth. I87.009, postthrombotic syndrome without complications, does not describe an ulcer and does not support a skin substitute.

In a Novitas, CGS or First Coast area, check the code against that LCD’s billing article before the claim leaves.

Documentation requirements for HCPCS Code Q4195

Every billed unit of Q4195 must trace back to a measurement in the chart. Reviewers check these elements first.

• Wound measurements: length, width and depth at each application, and the total area in cm².
• Units applied and units opened: the area of PuraPly placed on the wound and the sheet size opened.
• Product identification: PuraPly, not PuraPly AM, with lot number and expiration date.
• Wound history: wound type, duration and the standard care that failed before PuraPly was chosen.
• Application details: site, laterality, application number and the date, which must match the claim.
• Response to treatment: change in wound area since the last application, which supports a repeat application.

A chart that names PuraPly AM while the claim says Q4195 fails review. The product named in the note decides the code.

Common Q4195 denials and how to prevent them

Most Q4195 denials come from four places, which are the code, the claim form, the site of service and the record.

Track these by CARC, not just by claim. Our guide to denial codes in medical billing explains each group code and how to work the appeal.

How Pabau keeps Q4195 claims tied to the wound record

PuraPly claims fail when the chart and the claim are built in separate places. The measurement sits in one system, the product details in another, and someone retypes both into the claim.

Pabau, the practice management platform we build, keeps the wound record and the billing on one patient file. Your wound care form records the measurement, sheet size and lot number on that patient record at the visit.

The invoice then drives the claim. Before it goes out, staff check the units on the invoice against the area charted in the wound care form.

Pabau’s claims management raises the claim from the invoice and tracks it from Pending to Paid.

Bill skin substitutes from the wound record

Pabau keeps wound records, invoices and insurance claims in one system, so your team can check billed units against the chart.

Book a demo

Conclusion

If your templates still list Q4172, the fix is quick but it cannot wait. Every current PuraPly claim needs Q4195, and every PuraPly AM claim needs Q4196.

The harder work is the 2026 rules. A flat supply rate with no wastage payment rewards practices that size the sheet to the wound and chart the area at the visit.

Coverage now depends on your contractor more than on the code, so check it before the first application. Book a demo to see how Pabau keeps wound records, invoices and insurance claims in one system. Your team can then check billed units against the chart.

Continue your research

Billing a trunk, arm or leg wound? CPT code 15271 explains the application code that most often sits above a skin substitute line.

Comparing another collagen product? HCPCS Code Q4150 walks through Allowrap DS billing under the same 2026 rules.

Want fewer rejected wound care claims? Clean claim submission lists the pre-submission checks that keep claims out of the denial queue.

Reading remittances for skin substitute claims? Electronic remittance advice shows how to read the CARC codes on an 835 file.

Frequently asked questions