| Q2 |
Demo procedure, service |
Demonstration procedure/service |
| Q2004 |
Bladder calculi irrig sol |
Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml |
| Q2009 |
Fosphenytoin inj pe |
Injection, fosphenytoin, 50 mg phenytoin equivalent |
| Q2017 |
Teniposide, 50 mg |
Injection, teniposide, 50 mg |
| Q2026 |
Radiesse injection |
Injection, radiesse, 0.1 ml |
| Q2028 |
Inj, sculptra, 0.5mg |
Injection, sculptra, 0.5 mg |
| Q2034 |
Agriflu vaccine |
Influenza virus vaccine, split virus, for intramuscular use (agriflu) |
| Q2035 |
Afluria vacc, 3 yrs & >, im |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) |
| Q2036 |
Flulaval vacc, 3 yrs & >, im |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
| Q2037 |
Fluvirin vacc, 3 yrs & >, im |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) |
| Q2038 |
Fluzone vacc, 3 yrs & >, im |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
| Q2039 |
Influenza virus vaccine, nos |
Influenza virus vaccine, not otherwise specified |
| Q2040 |
Tisagenlecleucel car-pos t |
Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion |
| Q2041 |
Axicabtagene ciloleucel car+ |
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 car-pos t |
Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2043 |
Sipuleucel-t auto cd54+ |
Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion |
| Q2049 |
Imported lipodox inj |
Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg |
| Q2050 |
Doxorubicin inj 10mg |
Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg |
| Q2052 |
Home ivig, services/supplies |
Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig) |
| Q2053 |
Brexucabtagene car pos t |
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 mara car pos t |
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 car |
Idecabtagene vicleucel, up to 510 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2056 |
Ciltacabtagene car-pos t |
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 |
