Q4104 – Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
HCPCS Level II code · Q codes: Temporary Codes
HCPCS codeQ4104
- Long description
- Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
- Short description
- Integra bmwd
- Pricing indicator
11Priced using national RVUs (Physician Fee Schedule)- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
O1EOther drugs- ASC
- Approved for ambulatory surgical centers
- Added
- January 1, 2009
- Last change
- January 1, 2026 – No change
Frequently asked questions
What is HCPCS code Q4104?
Q4104 is a HCPCS Level II code for integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure).
Does Medicare cover Q4104?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby Q codes
- Q4051 – Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)
- Q4074 – Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms
- Q4081 – Injection, epoetin alfa, 100 units (for esrd on dialysis)
- Q4082 – Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)
- Q4100 – Skin substitute, not otherwise specified
- Q4101 – Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4102 – Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4103 – Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4105 – Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4106 – Dermagraft, per square centimeter
- Q4107 – Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4108 – Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4110 – Primatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4111 – Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure)
- Q4112 – Cymetra, injectable, 1 cc
- Q4113 – Graftjacket xpress, injectable, 1 cc
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.