Q4196 HCPCS code: Puraply am, per square centimeter
Q4196 is the HCPCS Level II code for puraply am, per square centimeter. In 2024 Medicare paid an average of $81.14 per service for Q4196 across 97,545 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 59% from 2022 to 2024 (239,950 to 97,545 services). In 2024, about 716 clinicians billed Medicare for Q4196 for 1,956 beneficiaries; California, Illinois, South Carolina accounted for 41% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2019-01-01 |
| Last action effective | 2024-01-01 |
Who bills Q4196 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 716 |
| Medicare beneficiaries | 1,956 |
| States with claims | 27 |
| Share of services in top 3 states (California, Illinois, South Carolina) | 41% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4196, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 239,950 | 3,900 | $108.03 | $86.14 |
| 2023 | 169,371 | 3,175 | $104.61 | $83.27 |
| 2024 | 97,545 | 1,956 | $101.92 | $81.14 |
States with the most Q4196 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 22,842 | $81.52 |
| Illinois | 7,475 | $81.50 |
| South Carolina | 6,455 | $81.66 |
| Kentucky | 5,654 | $81.63 |
| Georgia | 5,108 | $81.65 |
What changed for Q4196
- 2019-01-01: Q4196 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q4196?
Q4196 is the HCPCS Level II code for puraply am, per square centimeter. Short descriptor: "Puraply am 1 sq cm".
How much does Medicare pay for Q4196?
In 2024, the average Medicare payment was $81.14 per service (average allowed $101.92).
Does Medicare cover Q4196?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related Q41 codes
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- Q4103 — Oasis burn matrix, per square centimeter
- Q4104 — Integra bilayer matrix wound dressing (bmwd), per square centimeter
- Q4105 — Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter
- Q4106 — Dermagraft, per square centimeter
- Q4107 — Graftjacket, per square centimeter
- Q4108 — Integra matrix, per square centimeter
- Q4110 — Primatrix, per square centimeter
- Q4111 — Gammagraft, per square centimeter
- Q4112 — Cymetra, injectable, 1 cc
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q4196
- Watch Q4196 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4196
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.