Skip to main content
HCPCS Q4159 · Level II · skin substitute code

Q4159: Affinity, per square centimeter (add-on, list separately in addition to primary procedure), HCPCS Level II skin substitute code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for Q4159

Medicare payment
$127.26
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI S1
Skin substitute product paid separately
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS Q4159, added in 2015, as "Affinity, per square centimeter (add-on, list separately in addition to primary procedure)". National PFS payment for Q4159 is $127.26 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 3.81 practice-expense and 0.00 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $127.89 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). No current LCD or billing article lists Q4159; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS O1E (other drugs); pricing indicator 11; type of service 1 (medical care). Nearby codes: Q4158, Q4133, Q4186, Q4191.

Q4159 descriptor and code status

The October 2026 HCPCS Level II file describes Q4159 as “Affinity, per square centimeter (add-on, list separately in addition to primary procedure)”. It sits in the Q section (temporary codes), listed with the other Skin substitute codes (Q4101-Q4399 and A2001-A2050). Although searches often call it the "Q4159 CPT code", Q4159 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of Q4159
FieldValue
Short descriptorAffinity1 square cm
Added to HCPCS2015-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryO1E: other drugs
Type of service1: medical care

Medicare payment for Q4159

National PFS payment for Q4159 is $127.26 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 3.81 practice-expense and 0.00 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $127.89 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period ZZZ (add-on service inside the primary service's global period); PC/TC indicator 3 (technical component only).

PFS relative values and national payment for Q4159
ComponentNon-facilityFacility
Work RVU0.000.00
Practice expense RVU3.81NA
Malpractice RVU0.000.00
Total RVUs3.81NA
National payment (CF $33.4009)$127.26n/a
Qualifying APM participant (CF $33.5675)$127.89n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator S1 (Skin substitute product paid separately), APC 6000 (PMA Skin Substitute Products), national unadjusted payment $127.14 with a minimum unadjusted copayment of $25.43.

Ambulatory surgical center (Addendum BB)

Payment indicator S2 (Skin substitute supply group; paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate), national rate $127.14 at a payment weight of 2.2574.

Medically Unlikely Edits for Q4159

CMS publishes no MUE for Q4159 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for Q4159 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists Q4159 in v323r0.

Q4159 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check Q4159 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for Q4159

No current LCD or billing and coding article lists Q4159. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on Q4159

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for Q4159 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for Q4159 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS Q4159

What does HCPCS code Q4159 describe?

"Affinity, per square centimeter (add-on, list separately in addition to primary procedure)" (short descriptor "Affinity1 square cm"), in the Q section (temporary codes). Added 2015-01-01; last action N (no maintenance) effective 2026-01-01.

Is Q4159 a CPT code?

It is not. Q4159 belongs to the Q section (temporary codes) of HCPCS Level II, the CMS code set, not to AMA CPT. "Q4159 CPT code" searches refer to it.

What does Medicare pay for Q4159?

National PFS payment for Q4159 is $127.26 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 3.81 practice-expense and 0.00 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $127.89 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Does Medicare cover Q4159?

No current LCD or billing article lists Q4159; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.