Miscellaneous Services (Temporary Codes)
| Code | Description |
|---|---|
| Q0035 | Cardiokymography |
| Q0081 | Infusion therapy, using other than chemotherapeutic drugs, per visit |
| Q0083 | Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit |
| Q0084 | Chemotherapy administration by infusion technique only, per visit |
| Q0085 | Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
| Q0092 | Set-up portable x-ray equipment |
| Q0111 | Wet mounts, including preparations of vaginal, cervical or skin specimens |
| Q0112 | All potassium hydroxide (koh) preparations |
| Q0113 | Pinworm examinations |
| Q0114 | Fern test |
| Q0115 | Post-coital direct, qualitative examinations of vaginal or cervical mucous |
| Q0138 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) |
| Q0139 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis) |
| Q0144 | Azithromycin dihydrate, oral, capsules/powder, 1 gram |
| Q0161 | Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0162 | Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0163 | Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
| Q0164 | Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0166 | Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen |
| Q0167 | Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0169 | Promethazine hydrochloride, 12.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0173 | Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0174 | Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0175 | Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0177 | Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0180 | Dolasetron mesylate, 100 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen |
| Q0181 | Unspecified oral dosage form, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for a iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
| Q0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg |
| Q0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg |
| Q0222 | Injection, bebtelovimab, 175 mg |
| Q0239 | Injection, bamlanivimab-xxxx, 700 mg Terminated April 16, 2021. |
| Q0240 | Injection, casirivimab and imdevimab, 600 mg |
| Q0243 | Injection, casirivimab and imdevimab, 2400 mg |
| Q0244 | Injection, casirivimab and imdevimab, 1200 mg |
| Q0245 | Injection, bamlanivimab and etesevimab, 2100 mg |
| Q0247 | Injection, sotrovimab, 500 mg |
| Q0249 | Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg |
| Q0477 | Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0478 | Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type |
| Q0479 | Power module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0480 | Driver for use with pneumatic ventricular assist device, replacement only |
| Q0481 | Microprocessor control unit for use with electric ventricular assist device, replacement only |
| Q0482 | Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only |
| Q0483 | Monitor/display module for use with electric ventricular assist device, replacement only |
| Q0484 | Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0485 | Monitor control cable for use with electric ventricular assist device, replacement only |
| Q0486 | Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only |
| Q0487 | Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only |
| Q0488 | Power pack base for use with electric ventricular assist device, replacement only |
| Q0489 | Power pack base for use with electric/pneumatic ventricular assist device, replacement only |
| Q0490 | Emergency power source for use with electric ventricular assist device, replacement only |
| Q0491 | Emergency power source for use with electric/pneumatic ventricular assist device, replacement only |
| Q0492 | Emergency power supply cable for use with electric ventricular assist device, replacement only |
| Q0493 | Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only |
| Q0494 | Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0495 | Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0496 | Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0497 | Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0498 | Holster for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0499 | Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only |
| Q0500 | Filters for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0501 | Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0502 | Mobility cart for pneumatic ventricular assist device, replacement only |
| Q0503 | Battery for pneumatic ventricular assist device, replacement only, each |
| Q0504 | Power adapter for pneumatic ventricular assist device, replacement only, vehicle type |
| Q0506 | Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0507 | Miscellaneous supply or accessory for use with an external ventricular assist device |
| Q0508 | Miscellaneous supply or accessory for use with an implanted ventricular assist device |
| Q0509 | Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a |
| Q0510 | Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant |
| Q0511 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
| Q0512 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
| Q0513 | Pharmacy dispensing fee for inhalation drug(s); per 30 days |
| Q0514 | Pharmacy dispensing fee for inhalation drug(s); per 90 days |
| Q0515 | Injection, sermorelin acetate, 1 microgram |
| Q0516 | Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 30-days |
| Q0517 | Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 60-days |
| Q0518 | Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 90-days |
| Q1004 | New technology intraocular lens category 4 as defined in federal register notice |
| Q1005 | New technology intraocular lens category 5 as defined in federal register notice |
| Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml |
| Q2009 | Injection, fosphenytoin, 50 mg phenytoin equivalent |
| Q2017 | Injection, teniposide, 50 mg |
| Q2026 | Injection, radiesse, 0.1 ml |
| Q2028 | Injection, sculptra, 0.5 mg |
| Q2034 | Influenza virus vaccine, split virus, for intramuscular use (agriflu) |
| Q2035 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) |
| Q2036 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
| Q2037 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) |
| Q2038 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
| Q2039 | Influenza virus vaccine, not otherwise specified |
| Q2040 | Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion Terminated December 31, 2018. |
| Q2041 | Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2043 | Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg |
| Q2052 | Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig) |
| Q2053 | Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2054 | Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2055 | Idecabtagene vicleucel, up to 460 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2056 | Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q3001 | Radioelements for brachytherapy, any type, each |
| Q3014 | Telehealth originating site facility fee |
| Q3027 | Injection, interferon beta-1a, 1 mcg for intramuscular use |
| Q3028 | Injection, interferon beta-1a, 1 mcg for subcutaneous use |
| Q3031 | Collagen skin test |
| Q4001 | Casting supplies, body cast adult, with or without head, plaster |
| Q4002 | Cast supplies, body cast adult, with or without head, fiberglass |
| Q4003 | Cast supplies, shoulder cast, adult (11 years +), plaster |
| Q4004 | Cast supplies, shoulder cast, adult (11 years +), fiberglass |
| Q4005 | Cast supplies, long arm cast, adult (11 years +), plaster |
| Q4006 | Cast supplies, long arm cast, adult (11 years +), fiberglass |
| Q4007 | Cast supplies, long arm cast, pediatric (0-10 years), plaster |
| Q4008 | Cast supplies, long arm cast, pediatric (0-10 years), fiberglass |
| Q4009 | Cast supplies, short arm cast, adult (11 years +), plaster |
| Q4010 | Cast supplies, short arm cast, adult (11 years +), fiberglass |
| Q4011 | Cast supplies, short arm cast, pediatric (0-10 years), plaster |
| Q4012 | Cast supplies, short arm cast, pediatric (0-10 years), fiberglass |
| Q4013 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster |
| Q4014 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass |
| Q4015 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster |
| Q4016 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass |
| Q4017 | Cast supplies, long arm splint, adult (11 years +), plaster |
| Q4018 | Cast supplies, long arm splint, adult (11 years +), fiberglass |
| Q4019 | Cast supplies, long arm splint, pediatric (0-10 years), plaster |
| Q4020 | Cast supplies, long arm splint, pediatric (0-10 years), fiberglass |
| Q4021 | Cast supplies, short arm splint, adult (11 years +), plaster |
| Q4022 | Cast supplies, short arm splint, adult (11 years +), fiberglass |
| Q4023 | Cast supplies, short arm splint, pediatric (0-10 years), plaster |
| Q4024 | Cast supplies, short arm splint, pediatric (0-10 years), fiberglass |
| Q4025 | Cast supplies, hip spica (one or both legs), adult (11 years +), plaster |
| Q4026 | Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass |
| Q4027 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster |
| Q4028 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass |
| Q4029 | Cast supplies, long leg cast, adult (11 years +), plaster |
| Q4030 | Cast supplies, long leg cast, adult (11 years +), fiberglass |
| Q4031 | Cast supplies, long leg cast, pediatric (0-10 years), plaster |
| Q4032 | Cast supplies, long leg cast, pediatric (0-10 years), fiberglass |
| Q4033 | Cast supplies, long leg cylinder cast, adult (11 years +), plaster |
| Q4034 | Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass |
| Q4035 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster |
| Q4036 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass |
| Q4037 | Cast supplies, short leg cast, adult (11 years +), plaster |
| Q4038 | Cast supplies, short leg cast, adult (11 years +), fiberglass |
| Q4039 | Cast supplies, short leg cast, pediatric (0-10 years), plaster |
| Q4040 | Cast supplies, short leg cast, pediatric (0-10 years), fiberglass |
| Q4041 | Cast supplies, long leg splint, adult (11 years +), plaster |
| Q4042 | Cast supplies, long leg splint, adult (11 years +), fiberglass |
| Q4043 | Cast supplies, long leg splint, pediatric (0-10 years), plaster |
| Q4044 | Cast supplies, long leg splint, pediatric (0-10 years), fiberglass |
| Q4045 | Cast supplies, short leg splint, adult (11 years +), plaster |
| Q4046 | Cast supplies, short leg splint, adult (11 years +), fiberglass |
| Q4047 | Cast supplies, short leg splint, pediatric (0-10 years), plaster |
| Q4048 | Cast supplies, short leg splint, pediatric (0-10 years), fiberglass |
| Q4049 | Finger splint, static |
| Q4050 | Cast supplies, for unlisted types and materials of casts |
| Q4051 | Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) |
| Q4074 | Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) |
| Q4082 | Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap) |
| Q4100 | Skin substitute, not otherwise specified |
| Q4101 | Apligraf, per square centimeter |
| Q4102 | Oasis wound matrix, per square centimeter |
| Q4103 | Oasis burn matrix, per square centimeter |
| Q4104 | Integra bilayer matrix wound dressing (bmwd), per square centimeter |
| Q4105 | Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter |
| Q4106 | Dermagraft, per square centimeter |
| Q4107 | Graftjacket, per square centimeter |
| Q4108 | Integra matrix, per square centimeter |
| Q4110 | Primatrix, per square centimeter |
| Q4111 | Gammagraft, per square centimeter |
| Q4112 | Cymetra, injectable, 1 cc |
| Q4113 | Graftjacket xpress, injectable, 1 cc |
| Q4114 | Integra flowable wound matrix, injectable, 1 cc |
| Q4115 | Alloskin, per square centimeter |
| Q4116 | Alloderm, per square centimeter |
| Q4117 | Hyalomatrix, per square centimeter |
| Q4118 | Matristem micromatrix, 1 mg |
| Q4119 | Matristem wound matrix, per square centimeter Terminated December 31, 2016. |
| Q4120 | Matristem burn matrix, per square centimeter Terminated December 31, 2016. |
| Q4121 | Theraskin, per square centimeter |
| Q4122 | Dermacell, dermacell awm or dermacell awm porous, per square centimeter |
| Q4123 | Alloskin rt, per square centimeter |
| Q4124 | Oasis ultra tri-layer wound matrix, per square centimeter |
| Q4125 | Arthroflex, per square centimeter |
| Q4126 | Memoderm, dermaspan, tranzgraft or integuply, per square centimeter |
| Q4127 | Talymed, per square centimeter |
| Q4128 | Flex hd, or allopatch hd, per square centimeter |
| Q4129 | Unite biomatrix, per square centimeter Terminated December 31, 2016. |
| Q4130 | Strattice tm, per square centimeter |
| Q4131 | Epifix or epicord, per square centimeter Terminated December 31, 2018. |
| Q4132 | Grafix core and grafixpl core, per square centimeter |
| Q4133 | Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter |
| Q4134 | Hmatrix, per square centimeter |
| Q4135 | Mediskin, per square centimeter |
| Q4136 | Ez-derm, per square centimeter |
| Q4137 | Amnioexcel, amnioexcel plus or biodexcel, per square centimeter |
| Q4138 | Biodfence dryflex, per square centimeter |
| Q4139 | Amniomatrix or biodmatrix, injectable, 1 cc |
| Q4140 | Biodfence, per square centimeter |
| Q4141 | Alloskin ac, per square centimeter |
| Q4142 | Xcm biologic tissue matrix, per square centimeter |
| Q4143 | Repriza, per square centimeter |
| Q4145 | Epifix, injectable, 1 mg |
| Q4146 | Tensix, per square centimeter |
| Q4147 | Architect, architect px, or architect fx, extracellular matrix, per square centimeter |
| Q4148 | Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter |
| Q4149 | Excellagen, 0.1 cc |
| Q4150 | Allowrap ds or dry, per square centimeter |
| Q4151 | Amnioband or guardian, per square centimeter |
| Q4152 | Dermapure, per square centimeter |
| Q4153 | Dermavest and plurivest, per square centimeter |
| Q4154 | Biovance, per square centimeter |
| Q4155 | Neoxflo or clarixflo, 1 mg |
| Q4156 | Neox 100 or clarix 100, per square centimeter |
| Q4157 | Revitalon, per square centimeter |
| Q4158 | Kerecis omega3, per square centimeter |
| Q4159 | Affinity, per square centimeter |
| Q4160 | Nushield, per square centimeter |
| Q4161 | Bio-connekt wound matrix, per square centimeter |
| Q4162 | Woundex flow, bioskin flow, 0.5 cc |
| Q4163 | Woundex, bioskin, per square centimeter |
| Q4164 | Helicoll, per square centimeter |
| Q4165 | Keramatrix or kerasorb, per square centimeter |
| Q4166 | Cytal, per square centimeter |
| Q4167 | Truskin, per square centimeter |
| Q4168 | Amnioband, 1 mg |
| Q4169 | Artacent wound, per square centimeter |
| Q4170 | Cygnus, per square centimeter |
| Q4171 | Interfyl, 1 mg |
| Q4172 | Puraply or puraply am, per square centimeter Terminated December 31, 2018. |
| Q4173 | Palingen or palingen xplus, per square centimeter |
| Q4174 | Palingen or promatrx, 0.36 mg per 0.25 cc |
| Q4175 | Miroderm, per square centimeter |
| Q4176 | Neopatch or therion, per square centimeter |
| Q4177 | Floweramnioflo, 0.1 cc |
| Q4178 | Floweramniopatch, per square centimeter |
| Q4179 | Flowerderm, per square centimeter |
| Q4180 | Revita, per square centimeter |
| Q4181 | Amnio wound, per square centimeter |
| Q4182 | Transcyte, per square centimeter |
| Q4183 | Surgigraft, per square centimeter |
| Q4184 | Cellesta or cellesta duo, per square centimeter |
| Q4185 | Cellesta flowable amnion (25 mg per cc); per 0.5 cc |
| Q4186 | Epifix, per square centimeter |
| Q4187 | Epicord, per square centimeter |
| Q4188 | Amnioarmor, per square centimeter |
| Q4189 | Artacent ac, 1 mg |
| Q4190 | Artacent ac, per square centimeter |
| Q4191 | Restorigin, per square centimeter |
| Q4192 | Restorigin, 1 cc |
| Q4193 | Coll-e-derm, per square centimeter |
| Q4194 | Novachor, per square centimeter |
| Q4195 | Puraply, per square centimeter |
| Q4196 | Puraply am, per square centimeter |
| Q4197 | Puraply xt, per square centimeter |
| Q4198 | Genesis amniotic membrane, per square centimeter |
| Q4199 | Cygnus matrix, per square centimeter |
| Q4200 | Skin te, per square centimeter |
| Q4201 | Matrion, per square centimeter |
| Q4202 | Keroxx (2.5g/cc), 1cc |
| Q4203 | Derma-gide, per square centimeter |
| Q4204 | Xwrap, per square centimeter |
| Q4205 | Membrane graft or membrane wrap, per square centimeter |
| Q4206 | Fluid flow or fluid gf, 1 cc |
| Q4208 | Novafix, per square cenitmeter |
| Q4209 | Surgraft, per square centimeter |
| Q4210 | Axolotl graft or axolotl dualgraft, per square centimeter |
| Q4211 | Amnion bio or axobiomembrane, per square centimeter |
| Q4212 | Allogen, per cc |
| Q4213 | Ascent, 0.5 mg |
| Q4214 | Cellesta cord, per square centimeter |
| Q4215 | Axolotl ambient or axolotl cryo, 0.1 mg |
| Q4216 | Artacent cord, per square centimeter |
| Q4217 | Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter |
| Q4218 | Surgicord, per square centimeter |
| Q4219 | Surgigraft-dual, per square centimeter |
| Q4220 | Bellacell hd or surederm, per square centimeter |
| Q4221 | Amniowrap2, per square centimeter |
| Q4222 | Progenamatrix, per square centimeter |
| Q4224 | Human health factor 10 amniotic patch (hhf10-p), per square centimeter |
| Q4225 | Amniobind or dermabind tl, per square centimeter |
| Q4226 | Myown skin, includes harvesting and preparation procedures, per square centimeter |
| Q4227 | Amniocore, per square centimeter |
| Q4228 | Bionextpatch, per square centimeter Terminated September 30, 2021. |
| Q4229 | Cogenex amniotic membrane, per square centimeter |
| Q4230 | Cogenex flowable amnion, per 0.5 cc |
| Q4231 | Corplex p, per cc |
| Q4232 | Corplex, per square centimeter |
| Q4233 | Surfactor or nudyn, per 0.5 cc |
| Q4234 | Xcellerate, per square centimeter |
| Q4235 | Amniorepair or altiply, per square centimeter |
| Q4236 | Carepatch, per square centimeter |
| Q4237 | Cryo-cord, per square centimeter |
| Q4238 | Derm-maxx, per square centimeter |
| Q4239 | Amnio-maxx or amnio-maxx lite, per square centimeter |
| Q4240 | Corecyte, for topical use only, per 0.5 cc |
| Q4241 | Polycyte, for topical use only, per 0.5 cc |
| Q4242 | Amniocyte plus, per 0.5 cc |
| Q4244 | Procenta, per 200 mg Terminated March 31, 2024. |
| Q4245 | Amniotext, per cc |
| Q4246 | Coretext or protext, per cc |
| Q4247 | Amniotext patch, per square centimeter |
| Q4248 | Dermacyte amniotic membrane allograft, per square centimeter |
| Q4249 | Amniply, for topical use only, per square centimeter |
| Q4250 | Amnioamp-mp, per square centimeter |
| Q4251 | Vim, per square centimeter |
| Q4252 | Vendaje, per square centimeter |
| Q4253 | Zenith amniotic membrane, per square centimeter |
| Q4254 | Novafix dl, per square centimeter |
| Q4255 | Reguard, for topical use only, per square centimeter |
| Q4256 | Mlg-complete, per square centimeter |
| Q4257 | Relese, per square centimeter |
| Q4258 | Enverse, per square centimeter |
| Q4259 | Celera dual layer or celera dual membrane, per square centimeter |
| Q4260 | Signature apatch, per square centimeter |
| Q4261 | Tag, per square centimeter |
| Q4262 | Dual layer impax membrane, per square centimeter |
| Q4263 | Surgraft tl, per square centimeter |
| Q4264 | Cocoon membrane, per square centimeter |
| Q4265 | Neostim tl, per square centimeter |
| Q4266 | Neostim membrane, per square centimeter |
| Q4267 | Neostim dl, per square centimeter |
| Q4268 | Surgraft ft, per square centimeter |
| Q4269 | Surgraft xt, per square centimeter |
| Q4270 | Complete sl, per square centimeter |
| Q4271 | Complete ft, per square centimeter |
| Q4272 | Esano a, per square centimeter |
| Q4273 | Esano aaa, per square centimeter |
| Q4274 | Esano ac, per square centimeter |
| Q4275 | Esano aca, per square centimeter |
| Q4276 | Orion, per square centimeter |
| Q4277 | Woundplus membrane or e-graft, per square centimeter |
| Q4278 | Epieffect, per square centimeter |
| Q4279 | Vendaje ac, per square centimeter |
| Q4280 | Xcell amnio matrix, per square centimeter |
| Q4281 | Barrera sl or barrera dl, per square centimeter |
| Q4282 | Cygnus dual, per square centimeter |
| Q4283 | Biovance tri-layer or biovance 3l, per square centimeter |
| Q4284 | Dermabind sl, per square centimeter |
| Q4285 | Nudyn dl or nudyn dl mesh, per square centimeter |
| Q4286 | Nudyn sl or nudyn slw, per square centimeter |
| Q4287 | Dermabind dl, per square centimeter |
| Q4288 | Dermabind ch, per square centimeter |
| Q4289 | Revoshield + amniotic barrier, per square centimeter |
| Q4290 | Membrane wrap-hydro, per square centimeter |
| Q4291 | Lamellas xt, per square centimeter |
| Q4292 | Lamellas, per square centimeter |
| Q4293 | Acesso dl, per square centimeter |
| Q4294 | Amnio quad-core, per square centimeter |
| Q4295 | Amnio tri-core amniotic, per square centimeter |
| Q4296 | Rebound matrix, per square centimeter |
| Q4297 | Emerge matrix, per square centimeter |
| Q4298 | Amnicore pro, per square centimeter |
| Q4299 | Amnicore pro+, per square centimeter |
| Q4300 | Acesso tl, per square centimeter |
| Q4301 | Activate matrix, per square centimeter |
| Q4302 | Complete aca, per square centimeter |
| Q4303 | Complete aa, per square centimeter |
| Q4304 | Grafix plus, per square centimeter |
| Q4305 | American amnion ac tri-layer, per square centimeter |
| Q4306 | American amnion ac, per square centimeter |
| Q4307 | American amnion, per square centimeter |
| Q4308 | Sanopellis, per square centimeter |
| Q4309 | Via matrix, per square centimeter |
| Q4310 | Procenta, per 100 mg |
| Q5001 | Hospice or home health care provided in patient’s home/residence |
| Q5002 | Hospice or home health care provided in assisted living facility |
| Q5003 | Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) |
| Q5004 | Hospice care provided in skilled nursing facility (snf) |
| Q5005 | Hospice care provided in inpatient hospital |
| Q5006 | Hospice care provided in inpatient hospice facility |
| Q5007 | Hospice care provided in long term care facility |
| Q5008 | Hospice care provided in inpatient psychiatric facility |
| Q5009 | Hospice or home health care provided in place not otherwise specified (nos) |
| Q5010 | Hospice home care provided in a hospice facility |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram |
| Q5102 | Injection, infliximab, biosimilar, 10 mg Terminated March 31, 2018. |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg |
| Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg |
| Q5117 | Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg |
| Q5129 | Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg |
| Q5131 | Injection, adalimumab-aacf (idacio), biosimilar, 20 mg |
| Q5132 | Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg |
| Q5133 | Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg |
| Q5134 | Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg |
| Q9001 | Assessment by chaplain services |
| Q9002 | Counseling, individual, by chaplain services |
| Q9003 | Counseling, group, by chaplain services |
| Q9004 | Department of veterans affairs whole health partner services |
| Q9950 | Injection, sulfur hexafluoride lipid microspheres, per ml |
| Q9951 | Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml |
| Q9954 | Oral magnetic resonance contrast agent, per 100 ml |
| Q9955 | Injection, perflexane lipid microspheres, per ml |
| Q9956 | Injection, octafluoropropane microspheres, per ml |
| Q9957 | Injection, perflutren lipid microspheres, per ml |
| Q9958 | High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
| Q9959 | High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml |
| Q9960 | High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml |
| Q9961 | High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml |
| Q9962 | High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml |
| Q9963 | High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
| Q9964 | High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
| Q9966 | Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
| Q9968 | Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg |
| Q9969 | Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
| Q9970 | Injection, ferric carboxymaltose, 1mg Terminated December 31, 2014. |
| Q9972 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) Terminated December 31, 2014. |
| Q9973 | Injection, epoetin beta, 1 microgram, (non-esrd use) Terminated December 31, 2014. |
| Q9974 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg Terminated December 31, 2014. |
| Q9975 | Injection, factor viii fc fusion protein (recombinant), per iu Terminated December 31, 2015. |
| Q9976 | Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron Terminated December 31, 2015. |
| Q9977 | Compounded drug, not otherwise classified Terminated December 31, 2015. |
| Q9978 | Netupitant 300 mg and palonosetron 0.5 mg Terminated December 31, 2015. |
| Q9979 | Injection, alemtuzumab, 1 mg Terminated December 31, 2015. |
| Q9980 | Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg Terminated December 31, 2016. |
| Q9981 | Rolapitant, oral, 1 mg Terminated December 31, 2016. |
| Q9982 | Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries |
| Q9983 | Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries |
| Q9984 | Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg Terminated December 31, 2017. |
| Q9985 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg Terminated December 31, 2017. |
| Q9986 | Injection, hydroxyprogesterone caproate, (makena), 10 mg Terminated December 31, 2017. |
| Q9987 | Pathogen(s) test for platelets Terminated December 31, 2017. |
| Q9988 | Platelets, pheresis, pathogen-reduced, each unit Terminated December 31, 2017. |
| Q9989 | Ustekinumab, for intravenous injection, 1 mg Terminated December 31, 2017. |
| Q9991 | Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg |
| Q9992 | Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
| Q9993 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg Terminated December 31, 2018. |
| Q9994 | In-line cartridge containing digestive enzyme(s) for enteral feeding, each Terminated December 31, 2018. |
| Q9995 | Injection, emicizumab-kxwh, 0.5 mg Terminated December 31, 2018. |