Q4197 HCPCS code: Puraply xt, per square centimeter
Q4197 is the HCPCS Level II code for puraply xt, per square centimeter. In 2024 Medicare paid an average of $85.68 per service for Q4197 across 265,319 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume fell 61% from 2022 to 2024 (685,631 to 265,319 services). In 2024, about 1,050 clinicians billed Medicare for Q4197 for 3,148 beneficiaries; Florida, California, Illinois accounted for 31% 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 | 2019-01-01 |
Who bills Q4197 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,050 |
| Medicare beneficiaries | 3,148 |
| States with claims | 35 |
| Share of services in top 3 states (Florida, California, Illinois) | 31% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q4197, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 685,631 | 6,124 | $261.11 | $208.33 |
| 2023 | 420,319 | 4,513 | $160.54 | $127.86 |
| 2024 | 265,319 | 3,148 | $107.64 | $85.68 |
States with the most Q4197 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 30,381 | $85.73 |
| California | 29,405 | $86.67 |
| Illinois | 19,737 | $85.31 |
| Oklahoma | 18,187 | $88.34 |
| South Carolina | 17,151 | $79.66 |
What changed for Q4197
- 2019-01-01: Q4197 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 Q4197?
Q4197 is the HCPCS Level II code for puraply xt, per square centimeter. Short descriptor: "Puraply xt 1 sq cm".
How much does Medicare pay for Q4197?
In 2024, the average Medicare payment was $85.68 per service (average allowed $107.64).
Does Medicare cover Q4197?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
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- Q4106 — Dermagraft, per square centimeter
- Q4107 — Graftjacket, per square centimeter
- Q4108 — Integra matrix, per square centimeter
- Q4110 — Primatrix, per square centimeter
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- 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 Q4197
- Watch Q4197 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4197
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.