HCPCS ‘Q’ Codes (459)

Miscellaneous Services (Temporary Codes)
CodeDescription
Q0035Cardiokymography
Q0081Infusion therapy, using other than chemotherapeutic drugs, per visit
Q0083Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit
Q0084Chemotherapy administration by infusion technique only, per visit
Q0085Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit
Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
Q0092Set-up portable x-ray equipment
Q0111Wet mounts, including preparations of vaginal, cervical or skin specimens
Q0112All potassium hydroxide (koh) preparations
Q0113Pinworm examinations
Q0114Fern test
Q0115Post-coital direct, qualitative examinations of vaginal or cervical mucous
Q0138Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)
Q0139Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)
Q0144Azithromycin dihydrate, oral, capsules/powder, 1 gram
Q0161Chlorpromazine 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
Q0162Ondansetron 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
Q0163Diphenhydramine 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
Q0164Prochlorperazine 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
Q0166Granisetron 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
Q0167Dronabinol, 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
Q0169Promethazine 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
Q0173Trimethobenzamide 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
Q0174Thiethylperazine 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
Q0175Perphenazine, 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
Q0177Hydroxyzine 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
Q0180Dolasetron 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
Q0181Unspecified 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
Q0220Injection, 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
Q0221Injection, 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
Q0222Injection, bebtelovimab, 175 mg
Q0239Injection, bamlanivimab-xxxx, 700 mg
Terminated April 16, 2021.
Q0240Injection, casirivimab and imdevimab, 600 mg
Q0243Injection, casirivimab and imdevimab, 2400 mg
Q0244Injection, casirivimab and imdevimab, 1200 mg
Q0245Injection, bamlanivimab and etesevimab, 2100 mg
Q0247Injection, sotrovimab, 500 mg
Q0249Injection, 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
Q0477Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0478Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type
Q0479Power module for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0480Driver for use with pneumatic ventricular assist device, replacement only
Q0481Microprocessor control unit for use with electric ventricular assist device, replacement only
Q0482Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only
Q0483Monitor/display module for use with electric ventricular assist device, replacement only
Q0484Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0485Monitor control cable for use with electric ventricular assist device, replacement only
Q0486Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only
Q0487Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only
Q0488Power pack base for use with electric ventricular assist device, replacement only
Q0489Power pack base for use with electric/pneumatic ventricular assist device, replacement only
Q0490Emergency power source for use with electric ventricular assist device, replacement only
Q0491Emergency power source for use with electric/pneumatic ventricular assist device, replacement only
Q0492Emergency power supply cable for use with electric ventricular assist device, replacement only
Q0493Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only
Q0494Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0495Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0496Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0497Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0498Holster for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0499Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only
Q0500Filters for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0501Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0502Mobility cart for pneumatic ventricular assist device, replacement only
Q0503Battery for pneumatic ventricular assist device, replacement only, each
Q0504Power adapter for pneumatic ventricular assist device, replacement only, vehicle type
Q0506Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only
Q0507Miscellaneous supply or accessory for use with an external ventricular assist device
Q0508Miscellaneous supply or accessory for use with an implanted ventricular assist device
Q0509Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a
Q0510Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant
Q0511Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period
Q0512Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period
Q0513Pharmacy dispensing fee for inhalation drug(s); per 30 days
Q0514Pharmacy dispensing fee for inhalation drug(s); per 90 days
Q0515Injection, sermorelin acetate, 1 microgram
Q0516Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 30-days
Q0517Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 60-days
Q0518Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 90-days
Q1004New technology intraocular lens category 4 as defined in federal register notice
Q1005New technology intraocular lens category 5 as defined in federal register notice
Q2004Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
Q2009Injection, fosphenytoin, 50 mg phenytoin equivalent
Q2017Injection, teniposide, 50 mg
Q2026Injection, radiesse, 0.1 ml
Q2028Injection, sculptra, 0.5 mg
Q2034Influenza virus vaccine, split virus, for intramuscular use (agriflu)
Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
Q2039Influenza virus vaccine, not otherwise specified
Q2040Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
Terminated December 31, 2018.
Q2041Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Q2042Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Q2043Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
Q2049Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg
Q2050Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg
Q2052Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig)
Q2053Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Q2054Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Q2055Idecabtagene 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
Q2056Ciltacabtagene 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
Q3001Radioelements for brachytherapy, any type, each
Q3014Telehealth originating site facility fee
Q3027Injection, interferon beta-1a, 1 mcg for intramuscular use
Q3028Injection, interferon beta-1a, 1 mcg for subcutaneous use
Q3031Collagen skin test
Q4001Casting supplies, body cast adult, with or without head, plaster
Q4002Cast supplies, body cast adult, with or without head, fiberglass
Q4003Cast supplies, shoulder cast, adult (11 years +), plaster
Q4004Cast supplies, shoulder cast, adult (11 years +), fiberglass
Q4005Cast supplies, long arm cast, adult (11 years +), plaster
Q4006Cast supplies, long arm cast, adult (11 years +), fiberglass
Q4007Cast supplies, long arm cast, pediatric (0-10 years), plaster
Q4008Cast supplies, long arm cast, pediatric (0-10 years), fiberglass
Q4009Cast supplies, short arm cast, adult (11 years +), plaster
Q4010Cast supplies, short arm cast, adult (11 years +), fiberglass
Q4011Cast supplies, short arm cast, pediatric (0-10 years), plaster
Q4012Cast supplies, short arm cast, pediatric (0-10 years), fiberglass
Q4013Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster
Q4014Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass
Q4015Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster
Q4016Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass
Q4017Cast supplies, long arm splint, adult (11 years +), plaster
Q4018Cast supplies, long arm splint, adult (11 years +), fiberglass
Q4019Cast supplies, long arm splint, pediatric (0-10 years), plaster
Q4020Cast supplies, long arm splint, pediatric (0-10 years), fiberglass
Q4021Cast supplies, short arm splint, adult (11 years +), plaster
Q4022Cast supplies, short arm splint, adult (11 years +), fiberglass
Q4023Cast supplies, short arm splint, pediatric (0-10 years), plaster
Q4024Cast supplies, short arm splint, pediatric (0-10 years), fiberglass
Q4025Cast supplies, hip spica (one or both legs), adult (11 years +), plaster
Q4026Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass
Q4027Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster
Q4028Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass
Q4029Cast supplies, long leg cast, adult (11 years +), plaster
Q4030Cast supplies, long leg cast, adult (11 years +), fiberglass
Q4031Cast supplies, long leg cast, pediatric (0-10 years), plaster
Q4032Cast supplies, long leg cast, pediatric (0-10 years), fiberglass
Q4033Cast supplies, long leg cylinder cast, adult (11 years +), plaster
Q4034Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass
Q4035Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster
Q4036Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass
Q4037Cast supplies, short leg cast, adult (11 years +), plaster
Q4038Cast supplies, short leg cast, adult (11 years +), fiberglass
Q4039Cast supplies, short leg cast, pediatric (0-10 years), plaster
Q4040Cast supplies, short leg cast, pediatric (0-10 years), fiberglass
Q4041Cast supplies, long leg splint, adult (11 years +), plaster
Q4042Cast supplies, long leg splint, adult (11 years +), fiberglass
Q4043Cast supplies, long leg splint, pediatric (0-10 years), plaster
Q4044Cast supplies, long leg splint, pediatric (0-10 years), fiberglass
Q4045Cast supplies, short leg splint, adult (11 years +), plaster
Q4046Cast supplies, short leg splint, adult (11 years +), fiberglass
Q4047Cast supplies, short leg splint, pediatric (0-10 years), plaster
Q4048Cast supplies, short leg splint, pediatric (0-10 years), fiberglass
Q4049Finger splint, static
Q4050Cast supplies, for unlisted types and materials of casts
Q4051Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)
Q4074Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms
Q4081Injection, epoetin alfa, 100 units (for esrd on dialysis)
Q4082Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)
Q4100Skin substitute, not otherwise specified
Q4101Apligraf, per square centimeter
Q4102Oasis wound matrix, per square centimeter
Q4103Oasis burn matrix, per square centimeter
Q4104Integra bilayer matrix wound dressing (bmwd), per square centimeter
Q4105Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter
Q4106Dermagraft, per square centimeter
Q4107Graftjacket, per square centimeter
Q4108Integra matrix, per square centimeter
Q4110Primatrix, per square centimeter
Q4111Gammagraft, per square centimeter
Q4112Cymetra, injectable, 1 cc
Q4113Graftjacket xpress, injectable, 1 cc
Q4114Integra flowable wound matrix, injectable, 1 cc
Q4115Alloskin, per square centimeter
Q4116Alloderm, per square centimeter
Q4117Hyalomatrix, per square centimeter
Q4118Matristem micromatrix, 1 mg
Q4119Matristem wound matrix, per square centimeter
Terminated December 31, 2016.
Q4120Matristem burn matrix, per square centimeter
Terminated December 31, 2016.
Q4121Theraskin, per square centimeter
Q4122Dermacell, dermacell awm or dermacell awm porous, per square centimeter
Q4123Alloskin rt, per square centimeter
Q4124Oasis ultra tri-layer wound matrix, per square centimeter
Q4125Arthroflex, per square centimeter
Q4126Memoderm, dermaspan, tranzgraft or integuply, per square centimeter
Q4127Talymed, per square centimeter
Q4128Flex hd, or allopatch hd, per square centimeter
Q4129Unite biomatrix, per square centimeter
Terminated December 31, 2016.
Q4130Strattice tm, per square centimeter
Q4131Epifix or epicord, per square centimeter
Terminated December 31, 2018.
Q4132Grafix core and grafixpl core, per square centimeter
Q4133Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter
Q4134Hmatrix, per square centimeter
Q4135Mediskin, per square centimeter
Q4136Ez-derm, per square centimeter
Q4137Amnioexcel, amnioexcel plus or biodexcel, per square centimeter
Q4138Biodfence dryflex, per square centimeter
Q4139Amniomatrix or biodmatrix, injectable, 1 cc
Q4140Biodfence, per square centimeter
Q4141Alloskin ac, per square centimeter
Q4142Xcm biologic tissue matrix, per square centimeter
Q4143Repriza, per square centimeter
Q4145Epifix, injectable, 1 mg
Q4146Tensix, per square centimeter
Q4147Architect, architect px, or architect fx, extracellular matrix, per square centimeter
Q4148Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter
Q4149Excellagen, 0.1 cc
Q4150Allowrap ds or dry, per square centimeter
Q4151Amnioband or guardian, per square centimeter
Q4152Dermapure, per square centimeter
Q4153Dermavest and plurivest, per square centimeter
Q4154Biovance, per square centimeter
Q4155Neoxflo or clarixflo, 1 mg
Q4156Neox 100 or clarix 100, per square centimeter
Q4157Revitalon, per square centimeter
Q4158Kerecis omega3, per square centimeter
Q4159Affinity, per square centimeter
Q4160Nushield, per square centimeter
Q4161Bio-connekt wound matrix, per square centimeter
Q4162Woundex flow, bioskin flow, 0.5 cc
Q4163Woundex, bioskin, per square centimeter
Q4164Helicoll, per square centimeter
Q4165Keramatrix or kerasorb, per square centimeter
Q4166Cytal, per square centimeter
Q4167Truskin, per square centimeter
Q4168Amnioband, 1 mg
Q4169Artacent wound, per square centimeter
Q4170Cygnus, per square centimeter
Q4171Interfyl, 1 mg
Q4172Puraply or puraply am, per square centimeter
Terminated December 31, 2018.
Q4173Palingen or palingen xplus, per square centimeter
Q4174Palingen or promatrx, 0.36 mg per 0.25 cc
Q4175Miroderm, per square centimeter
Q4176Neopatch or therion, per square centimeter
Q4177Floweramnioflo, 0.1 cc
Q4178Floweramniopatch, per square centimeter
Q4179Flowerderm, per square centimeter
Q4180Revita, per square centimeter
Q4181Amnio wound, per square centimeter
Q4182Transcyte, per square centimeter
Q4183Surgigraft, per square centimeter
Q4184Cellesta or cellesta duo, per square centimeter
Q4185Cellesta flowable amnion (25 mg per cc); per 0.5 cc
Q4186Epifix, per square centimeter
Q4187Epicord, per square centimeter
Q4188Amnioarmor, per square centimeter
Q4189Artacent ac, 1 mg
Q4190Artacent ac, per square centimeter
Q4191Restorigin, per square centimeter
Q4192Restorigin, 1 cc
Q4193Coll-e-derm, per square centimeter
Q4194Novachor, per square centimeter
Q4195Puraply, per square centimeter
Q4196Puraply am, per square centimeter
Q4197Puraply xt, per square centimeter
Q4198Genesis amniotic membrane, per square centimeter
Q4199Cygnus matrix, per square centimeter
Q4200Skin te, per square centimeter
Q4201Matrion, per square centimeter
Q4202Keroxx (2.5g/cc), 1cc
Q4203Derma-gide, per square centimeter
Q4204Xwrap, per square centimeter
Q4205Membrane graft or membrane wrap, per square centimeter
Q4206Fluid flow or fluid gf, 1 cc
Q4208Novafix, per square cenitmeter
Q4209Surgraft, per square centimeter
Q4210Axolotl graft or axolotl dualgraft, per square centimeter
Q4211Amnion bio or axobiomembrane, per square centimeter
Q4212Allogen, per cc
Q4213Ascent, 0.5 mg
Q4214Cellesta cord, per square centimeter
Q4215Axolotl ambient or axolotl cryo, 0.1 mg
Q4216Artacent cord, per square centimeter
Q4217Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter
Q4218Surgicord, per square centimeter
Q4219Surgigraft-dual, per square centimeter
Q4220Bellacell hd or surederm, per square centimeter
Q4221Amniowrap2, per square centimeter
Q4222Progenamatrix, per square centimeter
Q4224Human health factor 10 amniotic patch (hhf10-p), per square centimeter
Q4225Amniobind or dermabind tl, per square centimeter
Q4226Myown skin, includes harvesting and preparation procedures, per square centimeter
Q4227Amniocore, per square centimeter
Q4228Bionextpatch, per square centimeter
Terminated September 30, 2021.
Q4229Cogenex amniotic membrane, per square centimeter
Q4230Cogenex flowable amnion, per 0.5 cc
Q4231Corplex p, per cc
Q4232Corplex, per square centimeter
Q4233Surfactor or nudyn, per 0.5 cc
Q4234Xcellerate, per square centimeter
Q4235Amniorepair or altiply, per square centimeter
Q4236Carepatch, per square centimeter
Q4237Cryo-cord, per square centimeter
Q4238Derm-maxx, per square centimeter
Q4239Amnio-maxx or amnio-maxx lite, per square centimeter
Q4240Corecyte, for topical use only, per 0.5 cc
Q4241Polycyte, for topical use only, per 0.5 cc
Q4242Amniocyte plus, per 0.5 cc
Q4244Procenta, per 200 mg
Terminated March 31, 2024.
Q4245Amniotext, per cc
Q4246Coretext or protext, per cc
Q4247Amniotext patch, per square centimeter
Q4248Dermacyte amniotic membrane allograft, per square centimeter
Q4249Amniply, for topical use only, per square centimeter
Q4250Amnioamp-mp, per square centimeter
Q4251Vim, per square centimeter
Q4252Vendaje, per square centimeter
Q4253Zenith amniotic membrane, per square centimeter
Q4254Novafix dl, per square centimeter
Q4255Reguard, for topical use only, per square centimeter
Q4256Mlg-complete, per square centimeter
Q4257Relese, per square centimeter
Q4258Enverse, per square centimeter
Q4259Celera dual layer or celera dual membrane, per square centimeter
Q4260Signature apatch, per square centimeter
Q4261Tag, per square centimeter
Q4262Dual layer impax membrane, per square centimeter
Q4263Surgraft tl, per square centimeter
Q4264Cocoon membrane, per square centimeter
Q4265Neostim tl, per square centimeter
Q4266Neostim membrane, per square centimeter
Q4267Neostim dl, per square centimeter
Q4268Surgraft ft, per square centimeter
Q4269Surgraft xt, per square centimeter
Q4270Complete sl, per square centimeter
Q4271Complete ft, per square centimeter
Q4272Esano a, per square centimeter
Q4273Esano aaa, per square centimeter
Q4274Esano ac, per square centimeter
Q4275Esano aca, per square centimeter
Q4276Orion, per square centimeter
Q4277Woundplus membrane or e-graft, per square centimeter
Q4278Epieffect, per square centimeter
Q4279Vendaje ac, per square centimeter
Q4280Xcell amnio matrix, per square centimeter
Q4281Barrera sl or barrera dl, per square centimeter
Q4282Cygnus dual, per square centimeter
Q4283Biovance tri-layer or biovance 3l, per square centimeter
Q4284Dermabind sl, per square centimeter
Q4285Nudyn dl or nudyn dl mesh, per square centimeter
Q4286Nudyn sl or nudyn slw, per square centimeter
Q4287Dermabind dl, per square centimeter
Q4288Dermabind ch, per square centimeter
Q4289Revoshield + amniotic barrier, per square centimeter
Q4290Membrane wrap-hydro, per square centimeter
Q4291Lamellas xt, per square centimeter
Q4292Lamellas, per square centimeter
Q4293Acesso dl, per square centimeter
Q4294Amnio quad-core, per square centimeter
Q4295Amnio tri-core amniotic, per square centimeter
Q4296Rebound matrix, per square centimeter
Q4297Emerge matrix, per square centimeter
Q4298Amnicore pro, per square centimeter
Q4299Amnicore pro+, per square centimeter
Q4300Acesso tl, per square centimeter
Q4301Activate matrix, per square centimeter
Q4302Complete aca, per square centimeter
Q4303Complete aa, per square centimeter
Q4304Grafix plus, per square centimeter
Q4305American amnion ac tri-layer, per square centimeter
Q4306American amnion ac, per square centimeter
Q4307American amnion, per square centimeter
Q4308Sanopellis, per square centimeter
Q4309Via matrix, per square centimeter
Q4310Procenta, per 100 mg
Q5001Hospice or home health care provided in patient’s home/residence
Q5002Hospice or home health care provided in assisted living facility
Q5003Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)
Q5004Hospice care provided in skilled nursing facility (snf)
Q5005Hospice care provided in inpatient hospital
Q5006Hospice care provided in inpatient hospice facility
Q5007Hospice care provided in long term care facility
Q5008Hospice care provided in inpatient psychiatric facility
Q5009Hospice or home health care provided in place not otherwise specified (nos)
Q5010Hospice home care provided in a hospice facility
Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
Q5102Injection, infliximab, biosimilar, 10 mg
Terminated March 31, 2018.
Q5103Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
Q5105Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
Q5109Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
Q5112Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg
Q5113Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg
Q5114Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg
Q5115Injection, rituximab-abbs, biosimilar, (truxima), 10 mg
Q5116Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
Q5117Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
Q5118Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg
Q5120Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg
Q5121Injection, infliximab-axxq, biosimilar, (avsola), 10 mg
Q5122Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg
Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mg
Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
Q5127Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg
Q5130Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg
Q5131Injection, adalimumab-aacf (idacio), biosimilar, 20 mg
Q5132Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg
Q5133Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
Q5134Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg
Q9001Assessment by chaplain services
Q9002Counseling, individual, by chaplain services
Q9003Counseling, group, by chaplain services
Q9004Department of veterans affairs whole health partner services
Q9950Injection, sulfur hexafluoride lipid microspheres, per ml
Q9951Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml
Q9953Injection, iron-based magnetic resonance contrast agent, per ml
Q9954Oral magnetic resonance contrast agent, per 100 ml
Q9955Injection, perflexane lipid microspheres, per ml
Q9956Injection, octafluoropropane microspheres, per ml
Q9957Injection, perflutren lipid microspheres, per ml
Q9958High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml
Q9959High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml
Q9960High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml
Q9961High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml
Q9962High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml
Q9963High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml
Q9964High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml
Q9965Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml
Q9966Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
Q9968Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg
Q9969Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose
Q9970Injection, ferric carboxymaltose, 1mg
Terminated December 31, 2014.
Q9972Injection, epoetin beta, 1 microgram, (for esrd on dialysis)
Terminated December 31, 2014.
Q9973Injection, epoetin beta, 1 microgram, (non-esrd use)
Terminated December 31, 2014.
Q9974Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg
Terminated December 31, 2014.
Q9975Injection, factor viii fc fusion protein (recombinant), per iu
Terminated December 31, 2015.
Q9976Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron
Terminated December 31, 2015.
Q9977Compounded drug, not otherwise classified
Terminated December 31, 2015.
Q9978Netupitant 300 mg and palonosetron 0.5 mg
Terminated December 31, 2015.
Q9979Injection, alemtuzumab, 1 mg
Terminated December 31, 2015.
Q9980Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg
Terminated December 31, 2016.
Q9981Rolapitant, oral, 1 mg
Terminated December 31, 2016.
Q9982Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries
Q9983Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries
Q9984Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg
Terminated December 31, 2017.
Q9985Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
Terminated December 31, 2017.
Q9986Injection, hydroxyprogesterone caproate, (makena), 10 mg
Terminated December 31, 2017.
Q9987Pathogen(s) test for platelets
Terminated December 31, 2017.
Q9988Platelets, pheresis, pathogen-reduced, each unit
Terminated December 31, 2017.
Q9989Ustekinumab, for intravenous injection, 1 mg
Terminated December 31, 2017.
Q9991Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg
Q9992Injection, buprenorphine extended-release (sublocade), greater than 100 mg
Q9993Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
Terminated December 31, 2018.
Q9994In-line cartridge containing digestive enzyme(s) for enteral feeding, each
Terminated December 31, 2018.
Q9995Injection, emicizumab-kxwh, 0.5 mg
Terminated December 31, 2018.