How much does Medicare pay for HCPCS Q4265?

Medicare allowed an average of $2070.67 per service and paid $1649.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2696.24, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q4265?

Neostim tl, per square centimeter. It was billed 21,287 times to 403 Medicare beneficiaries by 17 providers in 2024.

Does Q4265 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2071.29 in an office setting and $2050.24 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 Q4265 most?

Nurse Practitioner, with 5,518 services from 4 clinicians. Next are General Surgery, Podiatry, Otolaryngology.

HCPCS Q4265

Neostim tl, per square centimeter

$2070.67Medicare-allowed amount per service, averaged across 21,287 services

Providers submitted

$2696.24

Asking price, not received

Medicare allowed

$2070.67

The fee schedule figure

Medicare paid

$1649.80

Balance is patient coinsurance

Providers submitted an average of $2696.24 for this code and Medicare allowed $2070.67 — 1.3× 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 $1649.80 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2071.29
Hospital / facility: $2050.24

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 20,655 services were billed in an office setting and 632 in a facility.

Services: 21,287
Beneficiaries: 403
Providers billing it: 17
Total allowed: $44,078,352

What Medicare pays for HCPCS Q4265

Across 21,287 services billed by 17 providers to 403 beneficiaries, Medicare allowed an average of $2070.67 per service. That is 52.8 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 Q4265

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	5,518	66	$2080.86	4
General Surgery	5,258	22	$2043.44	1
Podiatry	2,777	42	$2073.55	3
Otolaryngology	2,438	103	$2080.86	1
Physician Assistant	2,014	17	$2080.86	1
Micrographic Dermatologic Surgery	1,694	88	$2080.86	2
Emergency Medicine	912	12	$2080.86	1
Dermatology	504	39	$2080.86	3
Family Practice	172	14	$2080.86	1

Q4265 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
Arizona	5,612	$2045.80	$1629.98	2
Illinois	5,267	$2080.73	$1657.82	4
California	5,092	$2080.82	$1657.89	3
Georgia	2,010	$2080.86	$1657.92	2
Texas	1,512	$2080.86	$1657.92	2
New York	912	$2080.86	$1657.92	1
Florida	830	$2057.55	$1639.35	2
Arkansas	52	$2080.86	$1657.92	1

Related codes

Q4205Membrane graft or membrane wrap$1301.16
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

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.