How much does Medicare pay for HCPCS Q4205?

Medicare allowed an average of $1301.16 per service and paid $1036.62 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1487.81, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q4205?

Membrane graft or membrane wrap, per square centimeter. It was billed 652,199 times to 7,535 Medicare beneficiaries by 288 providers in 2024.

Does Q4205 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1301.01 in an office setting and $1387.10 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 Q4205 most?

Nurse Practitioner, with 267,574 services from 179 clinicians. Next are Internal Medicine, Physician Assistant, Podiatry.

HCPCS Q4205

Membrane graft or membrane wrap, per square centimeter

$1301.16Medicare-allowed amount per service, averaged across 652,199 services

Providers submitted

$1487.81

Asking price, not received

Medicare allowed

$1301.16

The fee schedule figure

Medicare paid

$1036.62

Balance is patient coinsurance

Providers submitted an average of $1487.81 for this code and Medicare allowed $1301.16 — 1.1× 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 $1036.62 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1301.01
Hospital / facility: $1387.10

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 651,073 services were billed in an office setting and 1,126 in a facility.

Services: 652,199
Beneficiaries: 7,535
Providers billing it: 288
Total allowed: $848,615,251

What Medicare pays for HCPCS Q4205

Across 652,199 services billed by 288 providers to 7,535 beneficiaries, Medicare allowed an average of $1301.16 per service. That is 86.6 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 Q4205

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	267,574	3,667	$1298.33	179
Internal Medicine	95,822	529	$1314.02	5
Physician Assistant	83,952	941	$1285.21	26
Podiatry	62,588	365	$1301.42	19
Plastic and Reconstructive Surgery	41,514	112	$1308.19	4
Dermatology	32,504	1,112	$1294.39	22
Family Practice	26,238	219	$1322.94	11
General Practice	15,308	105	$1288.73	3
Cardiology	7,500	65	$1304.67	3
Pediatric Medicine	6,041	126	$1359.11	1
General Surgery	4,394	91	$1339.64	4
Orthopedic Surgery	2,284	24	$1286.45	2
Nephrology	1,730	13	$1302.93	1
Certified Clinical Nurse Specialist	1,290	26	$1257.07	1
Undersea and Hyperbaric Medicine	986	14	$1258.92	1

Q4205 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	227,833	$1299.96	$1035.70	44
Texas	88,421	$1289.48	$1028.09	46
Florida	51,422	$1297.41	$1033.60	42
Nevada	44,796	$1330.06	$1059.66	14
New York	27,380	$1282.73	$1022.01	7
Georgia	22,509	$1293.46	$1030.52	9
Arizona	22,322	$1292.66	$1029.80	18
Mississippi	20,719	$1316.80	$1048.77	19
Oregon	20,360	$1295.85	$1032.45	2
Kentucky	16,661	$1300.31	$1035.96	5
New Jersey	12,778	$1349.79	$1075.30	6
Illinois	11,346	$1315.25	$1047.91	3
Washington	11,312	$1302.98	$1038.04	7
North Carolina	11,113	$1285.19	$1023.97	4
Kansas	10,513	$1333.94	$1062.53	9
Alabama	9,328	$1336.16	$1064.46	7
Tennessee	7,742	$1315.05	$1047.55	9
Oklahoma	7,017	$1287.35	$1025.67	4
Louisiana	4,371	$1309.90	$1043.19	6
Colorado	4,124	$1260.95	$1004.64	7
New Mexico	3,864	$1250.69	$996.43	3
Indiana	3,190	$1286.54	$1025.05	2
Arkansas	2,822	$1284.86	$1023.62	4
Ohio	2,368	$1288.06	$1026.26	1
Virginia	1,618	$1289.98	$1027.79	2
District of Columbia	1,271	$1404.19	$1118.64	1
Pennsylvania	1,225	$1320.48	$1051.65	2
Massachusetts	994	$1234.73	$983.19	1
Idaho	955	$1317.45	$1049.68	1
Michigan	776	$1268.80	$1010.91	1
South Dakota	768	$1240.75	$988.56	1
Missouri	280	$1289.34	$1027.28	1

Related codes

Q4271Complete ft, per square centimeter$1655.29
Q4275Esano aca, per square centimeter$2621.95
Q4262Dual layer impax membrane$1135.62
Q4276Orion, per square centimeter$1335.32
Q4238Derm-maxx, per square centimeter$1119.08
Q4282Cygnus dual, per square centimeter$773.66
Q4236Carepatch, per square centimeter$758.90
Q4277Woundplus membrane or e-graft$1738.38
Q4299Amnicore pro+$2369.06
Q4239Amnio-maxx or amnio-maxx lite$2395.07
Q4278Epieffect, per square centimeter$409.48
Q4221Amniowrap2, per square centimeter$1751.50

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.