Q4105

ActiveAdd-on code

Integra drt or omnigraft

2026 Medicare payment

Estimated allowed amounts. Pick a locality or enter a ZIP; toggle modifiers to see how the payment rules change the number.

Locality

or ZIP

Show values as

Modifiers

Line	Qty	Non-facility (office)	Facility (hospital/ASC)
Q4105Integra drt or omnigraft	1	$127.26	$127.26

Conversion factor: Locality: national average GPCIs

RVU breakdown (national)

Relative value units before geographic adjustment. Payment = (work×GPCI_w + PE×GPCI_pe + MP×GPCI_mp) × CF

Row	Work RVU	PE RVU (office)	PE RVU (facility)	MP RVU	Total (office)
Q4105	0.00	3.81	3.81	0.00	3.81

Payment policy for Q4105

CMS's indicator fields, translated. These control which modifiers are payable and how.

Professional/technical (PC/TC)

pctc=3

Technical-only code

Stand-alone technical component (staff + equipment) of a diagnostic test.

Multiple procedures

mult_surg=0

No reduction

No multiple-procedure payment adjustment applies (typical for add-on codes).

Bilateral (modifier 50)

bilt_surg=0

150% rule doesn't apply

Bilateral adjustment does not apply (e.g., the code is unilateral by definition or physiology).

Assistant surgeon (80/81/82)

asst_surg=0

Payable with documentation

Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.

Co-surgeons (modifier 62)

co_surg=0

Not permitted

Co-surgeons (mod 62) may not be paid for this procedure.

Team surgery (modifier 66)

team_surg=0

Not permitted

Team surgery (mod 66) may not be paid for this procedure.

Source: pfs.data.cms.gov "Indicators for 2026", retrieved 2026-07-16; conversion factors $33.4009 / $33.5675 (QP) per CMS-1832-F. Estimated amounts — not billing or coding advice.