How much does Medicare pay for HCPCS Q4186?

Medicare allowed an average of $151.15 per service and paid $120.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $373.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q4186?

Epifix, per square centimeter. It was billed 96,300 times to 2,232 Medicare beneficiaries by 78 providers in 2024.

Does Q4186 pay differently in an office than a hospital?

Yes. The allowed amount averaged $151.15 in an office setting and $151.44 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills Q4186 most?

Nurse Practitioner, with 19,692 services from 11 clinicians. Next are Podiatry, General Surgery, Dermatology.

HCPCS Q4186

Epifix, per square centimeter

$151.15Medicare-allowed amount per service, averaged across 96,300 services

Providers submitted

$373.58

Asking price, not received

Medicare allowed

$151.15

The fee schedule figure

Medicare paid

$120.29

Balance is patient coinsurance

Providers submitted an average of $373.58 for this code and Medicare allowed $151.15 — 2.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $120.29 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $151.15
Hospital / facility: $151.44

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 95,701 services were billed in an office setting and 599 in a facility.

Services: 96,300
Beneficiaries: 2,232
Providers billing it: 78
Total allowed: $14,555,745

What Medicare pays for HCPCS Q4186

Across 96,300 services billed by 78 providers to 2,232 beneficiaries, Medicare allowed an average of $151.15 per service. That is 43.1 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills Q4186

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	19,692	181	$151.75	11
Podiatry	19,326	232	$151.94	13
General Surgery	11,674	72	$150.60	3
Dermatology	11,487	578	$151.43	23
Otolaryngology	8,385	364	$151.33	1
Plastic and Reconstructive Surgery	6,355	90	$151.00	4
Preventive Medicine	4,609	18	$149.90	1
Micrographic Dermatologic Surgery	4,101	414	$151.81	6
Physician Assistant	3,718	111	$150.41	7
Orthopedic Surgery	1,617	26	$149.22	1
Infectious Disease	1,513	26	$149.71	1
Emergency Medicine	1,280	43	$140.71	2
Vascular Surgery	1,109	19	$151.25	1
Family Practice	779	28	$150.88	2
Internal Medicine	525	19	$151.83	1

Q4186 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	34,823	$151.33	$120.73	19
Kentucky	13,553	$150.80	$120.01	6
Illinois	10,725	$151.41	$120.59	8
Kansas	5,827	$152.33	$121.21	4
Minnesota	5,043	$150.41	$119.67	3
Alabama	4,675	$151.36	$122.65	2
Florida	3,893	$150.07	$120.21	4
Washington	3,218	$151.77	$120.90	2
Texas	2,695	$151.45	$120.67	1
New Hampshire	2,286	$151.74	$120.81	5
Massachusetts	2,090	$151.98	$120.94	3
Oregon	1,310	$151.94	$121.04	5
Michigan	969	$151.91	$120.96	2
Ohio	954	$151.88	$121.01	3
Nevada	760	$151.83	$120.97	2
Nebraska	744	$140.71	$112.11	1
Wisconsin	665	$150.92	$120.12	2
North Carolina	555	$150.71	$119.84	2
Colorado	536	$140.71	$112.11	1
New York	494	$152.18	$121.15	2
Arizona	485	$151.36	$120.88	1

Related codes

Q4191Restorigin, per square centimeter$1480.98
Q4164Helicoll, per square centimeter$1533.07
Q4197Puraply xt, per square centimeter$104.89
Q4194Novachor, per square centimeter$982.49
Q4196Puraply am, per square centimeter$102.33
Q4158Kerecis omega3$146.69
Q4180Revita, per square centimeter$511.91
Q4159Affinity, per square centimeter$302.38
Q4190Artacent ac, per square centimeter$332.58
Q4188Amnioarmor, per square centimeter$832.88

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.