| Q0 |
Invest clinical research |
Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
| Q0035 |
Cardiokymography |
Cardiokymography |
| Q0081 |
Infusion ther other than che |
Infusion therapy, using other than chemotherapeutic drugs, per visit |
| Q0083 |
Chemo by other than infusion |
Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit |
| Q0084 |
Chemotherapy by infusion |
Chemotherapy administration by infusion technique only, per visit |
| Q0085 |
Chemo by both infusion and o |
Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit |
| Q0091 |
Obtaining screen pap smear |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
| Q0092 |
Set up port xray equipment |
Set-up portable x-ray equipment |
| Q0111 |
Wet mounts/ w preparations |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
| Q0112 |
Potassium hydroxide preps |
All potassium hydroxide (koh) preparations |
| Q0113 |
Pinworm examinations |
Pinworm examinations |
| Q0114 |
Fern test |
Fern test |
| Q0115 |
Post-coital mucous exam |
Post-coital direct, qualitative examinations of vaginal or cervical mucous |
| Q0138 |
Ferumoxytol, non-esrd |
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) |
| Q0139 |
Ferumoxytol, esrd use |
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis) |
| Q0144 |
Azithromycin dihydrate, oral |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
| Q0161 |
Chlorpromazine hcl 5mg oral |
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 oral |
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 hcl 50mg |
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 5mg |
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 hcl 1 mg oral |
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 2.5mg oral |
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 hcl 12.5mg oral |
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 hcl 250mg |
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 maleate10mg |
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 4mg oral |
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 25mg |
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 oral |
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 anti-emetic |
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 |
Tixagev and cilgav, 300mg |
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 |
Tixagev and cilgav, 600mg |
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 |
Bebtelovimab 175 mg |
Injection, bebtelovimab, 175 mg |
| Q0224 |
Inj, pemivibart, 4500 mg |
Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg |
| Q0239 |
Bamlanivimab-xxxx |
Injection, bamlanivimab-xxxx, 700 mg |
| Q0240 |
Casirivi and imdevi 600 mg |
Injection, casirivimab and imdevimab, 600 mg |
| Q0243 |
Casirivimab and imdevimab |
Injection, casirivimab and imdevimab, 2400 mg |
| Q0244 |
Casirivi and imdevi 1200 mg |
Injection, casirivimab and imdevimab, 1200 mg |
| Q0245 |
Bamlanivimab and etesevima |
Injection, bamlanivimab and etesevimab, 2100 mg |
| Q0247 |
Sotrovimab |
Injection, sotrovimab, 500 mg |
| Q0249 |
Tocilizumab for covid-19 |
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 |
Pwr module pt cable lvad rpl |
Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0478 |
Power adapter, combo vad |
Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type |
| Q0479 |
Power module combo vad, rep |
Power module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0480 |
Driver pneumatic vad, rep |
Driver for use with pneumatic ventricular assist device, replacement only |
| Q0481 |
Microprcsr cu elec vad, rep |
Microprocessor control unit for use with electric ventricular assist device, replacement only |
| Q0482 |
Microprcsr cu combo vad, rep |
Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only |
| Q0483 |
Monitor elec vad, rep |
Monitor/display module for use with electric ventricular assist device, replacement only |
| Q0484 |
Monitor elec or comb vad rep |
Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0485 |
Monitor cable elec vad, rep |
Monitor control cable for use with electric ventricular assist device, replacement only |
| Q0486 |
Mon cable elec/pneum vad rep |
Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only |
| Q0487 |
Leads any type vad, rep only |
Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only |
| Q0488 |
Pwr pack base elec vad, rep |
Power pack base for use with electric ventricular assist device, replacement only |
| Q0489 |
Pwr pck base combo vad, rep |
Power pack base for use with electric/pneumatic ventricular assist device, replacement only |
| Q0490 |
Emr pwr source elec vad, rep |
Emergency power source for use with electric ventricular assist device, replacement only |
| Q0491 |
Emr pwr source combo vad rep |
Emergency power source for use with electric/pneumatic ventricular assist device, replacement only |
| Q0492 |
Emr pwr cbl elec vad, rep |
Emergency power supply cable for use with electric ventricular assist device, replacement only |
| Q0493 |
Emr pwr cbl combo vad, rep |
Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only |
| Q0494 |
Emr hd pmp elec/combo, rep |
Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0495 |
Charger elec/combo vad, rep |
Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0496 |
Battery elec/combo vad, rep |
Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0497 |
Bat clps elec/comb vad, rep |
Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0498 |
Holster elec/combo vad, rep |
Holster for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0499 |
Belt/vest elec/combo vad rep |
Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only |
| Q0500 |
Filters elec/combo vad, rep |
Filters for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0501 |
Shwr cov elec/combo vad, rep |
Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0502 |
Mobility cart pneum vad, rep |
Mobility cart for pneumatic ventricular assist device, replacement only |
| Q0503 |
Battery pneum vad replacemnt |
Battery for pneumatic ventricular assist device, replacement only, each |
| Q0504 |
Pwr adpt pneum vad, rep veh |
Power adapter for pneumatic ventricular assist device, replacement only, vehicle type |
| Q0506 |
Lith-ion batt elec/pneum vad |
Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0507 |
Misc sup/acc ext vad |
Miscellaneous supply or accessory for use with an external ventricular assist device |
| Q0508 |
Mis sup/acc imp vad |
Miscellaneous supply or accessory for use with an implanted ventricular assist device |
| Q0509 |
Mis sup/ac imp vad nopay med |
Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a |
| Q0510 |
Dispens fee immunosupressive |
Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant |
| Q0511 |
Sup fee antiem,antica,immuno |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
| Q0512 |
Px sup fee anti-can sub pres |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
| Q0513 |
Disp fee inhal drugs/30 days |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
| Q0514 |
Disp fee inhal drugs/90 days |
Pharmacy dispensing fee for inhalation drug(s); per 90 days |
| Q0515 |
Sermorelin acetate injection |
Injection, sermorelin acetate, 1 microgram |
| Q0516 |
Supply fee hiv prep 30-days |
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 30-days |
| Q0517 |
Supply fee hiv prep 60-days |
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 60-days |
| Q0518 |
Supply fee hiv prep 90-days |
Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription drug, per 90-days |
| Q1 |
Routine clinical research |
Routine clinical service provided in a clinical research study that is in an approved clinical research study |
| Q1004 |
Ntiol category 4 |
New technology intraocular lens category 4 as defined in federal register notice |
| Q1005 |
Ntiol category 5 |
New technology intraocular lens category 5 as defined in federal register notice |
| 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 |
| Q3 |
Live donor surgery/services |
Live kidney donor surgery and related services |
| Q3001 |
Brachytherapy radioelements |
Radioelements for brachytherapy, any type, each |
| Q3014 |
Telehealth facility fee |
Telehealth originating site facility fee |
| Q3027 |
Inj beta interferon im 1 mcg |
Injection, interferon beta-1a, 1 mcg for intramuscular use |
| Q3028 |
Inj beta interferon sq 1 mcg |
Injection, interferon beta-1a, 1 mcg for subcutaneous use |
| Q3031 |
Collagen skin test |
Collagen skin test |
| Q4 |
Svc exempt - ordrg/rfrng md |
Service for ordering/referring physician qualifies as a service exemption |
| Q4001 |
Cast sup body cast plaster |
Casting supplies, body cast adult, with or without head, plaster |
| Q4002 |
Cast sup body cast fiberglas |
Cast supplies, body cast adult, with or without head, fiberglass |
| Q4003 |
Cast sup shoulder cast plstr |
Cast supplies, shoulder cast, adult (11 years +), plaster |
| Q4004 |
Cast sup shoulder cast fbrgl |
Cast supplies, shoulder cast, adult (11 years +), fiberglass |
| Q4005 |
Cast sup long arm adult plst |
Cast supplies, long arm cast, adult (11 years +), plaster |
| Q4006 |
Cast sup long arm adult fbrg |
Cast supplies, long arm cast, adult (11 years +), fiberglass |
| Q4007 |
Cast sup long arm ped plster |
Cast supplies, long arm cast, pediatric (0-10 years), plaster |
| Q4008 |
Cast sup long arm ped fbrgls |
Cast supplies, long arm cast, pediatric (0-10 years), fiberglass |
| Q4009 |
Cast sup sht arm adult plstr |
Cast supplies, short arm cast, adult (11 years +), plaster |
| Q4010 |
Cast sup sht arm adult fbrgl |
Cast supplies, short arm cast, adult (11 years +), fiberglass |
| Q4011 |
Cast sup sht arm ped plaster |
Cast supplies, short arm cast, pediatric (0-10 years), plaster |
| Q4012 |
Cast sup sht arm ped fbrglas |
Cast supplies, short arm cast, pediatric (0-10 years), fiberglass |
| Q4013 |
Cast sup gauntlet plaster |
Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster |
| Q4014 |
Cast sup gauntlet fiberglass |
Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass |
| Q4015 |
Cast sup gauntlet ped plster |
Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster |
| Q4016 |
Cast sup gauntlet ped fbrgls |
Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass |
| Q4017 |
Cast sup lng arm splint plst |
Cast supplies, long arm splint, adult (11 years +), plaster |
| Q4018 |
Cast sup lng arm splint fbrg |
Cast supplies, long arm splint, adult (11 years +), fiberglass |
| Q4019 |
Cast sup lng arm splnt ped p |
Cast supplies, long arm splint, pediatric (0-10 years), plaster |
| Q4020 |
Cast sup lng arm splnt ped f |
Cast supplies, long arm splint, pediatric (0-10 years), fiberglass |
| Q4021 |
Cast sup sht arm splint plst |
Cast supplies, short arm splint, adult (11 years +), plaster |
| Q4022 |
Cast sup sht arm splint fbrg |
Cast supplies, short arm splint, adult (11 years +), fiberglass |
| Q4023 |
Cast sup sht arm splnt ped p |
Cast supplies, short arm splint, pediatric (0-10 years), plaster |
| Q4024 |
Cast sup sht arm splnt ped f |
Cast supplies, short arm splint, pediatric (0-10 years), fiberglass |
| Q4025 |
Cast sup hip spica plaster |
Cast supplies, hip spica (one or both legs), adult (11 years +), plaster |
| Q4026 |
Cast sup hip spica fiberglas |
Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass |
| Q4027 |
Cast sup hip spica ped plstr |
Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster |
| Q4028 |
Cast sup hip spica ped fbrgl |
Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass |
| Q4029 |
Cast sup long leg plaster |
Cast supplies, long leg cast, adult (11 years +), plaster |
| Q4030 |
Cast sup long leg fiberglass |
Cast supplies, long leg cast, adult (11 years +), fiberglass |
| Q4031 |
Cast sup lng leg ped plaster |
Cast supplies, long leg cast, pediatric (0-10 years), plaster |
| Q4032 |
Cast sup lng leg ped fbrgls |
Cast supplies, long leg cast, pediatric (0-10 years), fiberglass |
| Q4033 |
Cast sup lng leg cylinder pl |
Cast supplies, long leg cylinder cast, adult (11 years +), plaster |
| Q4034 |
Cast sup lng leg cylinder fb |
Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass |
| Q4035 |
Cast sup lngleg cylndr ped p |
Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster |
| Q4036 |
Cast sup lngleg cylndr ped f |
Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass |
| Q4037 |
Cast sup shrt leg plaster |
Cast supplies, short leg cast, adult (11 years +), plaster |
| Q4038 |
Cast sup shrt leg fiberglass |
Cast supplies, short leg cast, adult (11 years +), fiberglass |
| Q4039 |
Cast sup shrt leg ped plster |
Cast supplies, short leg cast, pediatric (0-10 years), plaster |
| Q4040 |
Cast sup shrt leg ped fbrgls |
Cast supplies, short leg cast, pediatric (0-10 years), fiberglass |
| Q4041 |
Cast sup lng leg splnt plstr |
Cast supplies, long leg splint, adult (11 years +), plaster |
| Q4042 |
Cast sup lng leg splnt fbrgl |
Cast supplies, long leg splint, adult (11 years +), fiberglass |
| Q4043 |
Cast sup lng leg splnt ped p |
Cast supplies, long leg splint, pediatric (0-10 years), plaster |
| Q4044 |
Cast sup lng leg splnt ped f |
Cast supplies, long leg splint, pediatric (0-10 years), fiberglass |
| Q4045 |
Cast sup sht leg splnt plstr |
Cast supplies, short leg splint, adult (11 years +), plaster |
| Q4046 |
Cast sup sht leg splnt fbrgl |
Cast supplies, short leg splint, adult (11 years +), fiberglass |
| Q4047 |
Cast sup sht leg splnt ped p |
Cast supplies, short leg splint, pediatric (0-10 years), plaster |
| Q4048 |
Cast sup sht leg splnt ped f |
Cast supplies, short leg splint, pediatric (0-10 years), fiberglass |
| Q4049 |
Finger splint, static |
Finger splint, static |
| Q4050 |
Cast supplies unlisted |
Cast supplies, for unlisted types and materials of casts |
| Q4051 |
Splint supplies misc |
Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) |
| Q4074 |
Iloprost non-comp unit dose |
Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms |
| Q4081 |
Epoetin alfa, 100 units esrd |
Injection, epoetin alfa, 100 units (for esrd on dialysis) |
| Q4082 |
Drug/bio noc part b drug cap |
Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap) |
| Q4100 |
Skin substitute, nos |
Skin substitute, not otherwise specified |
| Q4101 |
Apligraf |
Apligraf, per square centimeter |
| Q4102 |
Oasis wound matrix |
Oasis wound matrix, per square centimeter |
| Q4103 |
Oasis burn matrix |
Oasis burn matrix, per square centimeter |
| Q4104 |
Integra bmwd |
Integra bilayer matrix wound dressing (bmwd), per square centimeter |
| Q4105 |
Integra drt or omnigraft |
Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter |
| Q4106 |
Dermagraft |
Dermagraft, per square centimeter |
| Q4107 |
Graftjacket |
Graftjacket, per square centimeter |
| Q4108 |
Integra matrix |
Integra matrix, per square centimeter |
| Q4110 |
Primatrix |
Primatrix, per square centimeter |
| Q4111 |
Gammagraft |
Gammagraft, per square centimeter |
| Q4112 |
Cymetra injectable |
Cymetra, injectable, 1 cc |
| Q4113 |
Graftjacket xpress |
Graftjacket xpress, injectable, 1 cc |
| Q4114 |
Integra flowable wound matri |
Integra flowable wound matrix, injectable, 1 cc |
| Q4115 |
Alloskin |
Alloskin, per square centimeter |
| Q4116 |
Alloderm |
Alloderm, per square centimeter |
| Q4117 |
Hyalomatrix |
Hyalomatrix, per square centimeter |
| Q4118 |
Matristem micromatrix |
Matristem micromatrix, 1 mg |
| Q4119 |
Matristem wound matrix |
Matristem wound matrix, per square centimeter |
| Q4120 |
Matristem burn matrix |
Matristem burn matrix, per square centimeter |
| Q4121 |
Theraskin |
Theraskin, per square centimeter |
| Q4122 |
Dermacell, awm, porous sq cm |
Dermacell, dermacell awm or dermacell awm porous, per square centimeter |
| Q4123 |
Alloskin |
Alloskin rt, per square centimeter |
| Q4124 |
Oasis tri-layer wound matrix |
Oasis ultra tri-layer wound matrix, per square centimeter |
| Q4125 |
Arthroflex |
Arthroflex, per square centimeter |
| Q4126 |
Memoderm/derma/tranz/integup |
Memoderm, dermaspan, tranzgraft or integuply, per square centimeter |
| Q4127 |
Talymed |
Talymed, per square centimeter |
| Q4128 |
Flexhd/allopatchhd/sq cm |
Flex hd, or allopatch hd, per square centimeter |
| Q4129 |
Unite biomatrix |
Unite biomatrix, per square centimeter |
| Q4130 |
Strattice tm |
Strattice tm, per square centimeter |
| Q4131 |
Epifix or epicord |
Epifix or epicord, per square centimeter |
| Q4132 |
Grafix core, grafixpl core |
Grafix core and grafixpl core, per square centimeter |
| Q4133 |
Grafix stravix prime pl sqcm |
Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter |
| Q4134 |
Hmatrix |
Hmatrix, per square centimeter |
| Q4135 |
Mediskin |
Mediskin, per square centimeter |
| Q4136 |
Ezderm |
Ez-derm, per square centimeter |
| Q4137 |
Amnioexcel biodexcel 1sq cm |
Amnioexcel, amnioexcel plus or biodexcel, per square centimeter |
| Q4138 |
Biodfence dryflex, 1cm |
Biodfence dryflex, per square centimeter |
| Q4139 |
Amnio or biodmatrix, inj 1cc |
Amniomatrix or biodmatrix, injectable, 1 cc |
| Q4140 |
Biodfence 1cm |
Biodfence, per square centimeter |
| Q4141 |
Alloskin ac, 1 cm |
Alloskin ac, per square centimeter |
| Q4142 |
Xcm biologic tiss matrix 1cm |
Xcm biologic tissue matrix, per square centimeter |
| Q4143 |
Repriza, 1cm |
Repriza, per square centimeter |
| Q4145 |
Epifix, inj, 1mg |
Epifix, injectable, 1 mg |
| Q4146 |
Tensix, 1cm |
Tensix, per square centimeter |
| Q4147 |
Architect ecm px fx 1 sq cm |
Architect, architect px, or architect fx, extracellular matrix, per square centimeter |
| Q4148 |
Neox neox rt or clarix cord |
Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter |
| Q4149 |
Excellagen, 0.1 cc |
Excellagen, 0.1 cc |
| Q4150 |
Allowrap ds or dry 1 sq cm |
Allowrap ds or dry, per square centimeter |
| Q4151 |
Amnioband, guardian 1 sq cm |
Amnioband or guardian, per square centimeter |
| Q4152 |
Dermapure 1 square cm |
Dermapure, per square centimeter |
| Q4153 |
Dermavest, plurivest sq cm |
Dermavest and plurivest, per square centimeter |
| Q4154 |
Biovance 1 square cm |
Biovance, per square centimeter |
| Q4155 |
Neoxflo or clarixflo 1 mg |
Neoxflo or clarixflo, 1 mg |
| Q4156 |
Neox 100 or clarix 100 |
Neox 100 or clarix 100, per square centimeter |
| Q4157 |
Revitalon 1 square cm |
Revitalon, per square centimeter |
| Q4158 |
Kerecis omega3, per sq cm |
Kerecis omega3, per square centimeter |
| Q4159 |
Affinity1 square cm |
Affinity, per square centimeter |
| Q4160 |
Nushield 1 square cm |
Nushield, per square centimeter |
| Q4161 |
Bio-connekt per square cm |
Bio-connekt wound matrix, per square centimeter |
| Q4162 |
Wndex flw, bioskn flw, 0.5cc |
Woundex flow, bioskin flow, 0.5 cc |
| Q4163 |
Woundex, bioskin, per sq cm |
Woundex, bioskin, per square centimeter |
| Q4164 |
Helicoll, per square cm |
Helicoll, per square centimeter |
| Q4165 |
Keramatrix, kerasorb sq cm |
Keramatrix or kerasorb, per square centimeter |
| Q4166 |
Cytal, per square centimeter |
Cytal, per square centimeter |
| Q4167 |
Truskin, per sq centimeter |
Truskin, per square centimeter |
| Q4168 |
Amnioband, 1 mg |
Amnioband, 1 mg |
| Q4169 |
Artacent wound, per sq cm |
Artacent wound, per square centimeter |
| Q4170 |
Cygnus, per sq cm |
Cygnus, per square centimeter |
| Q4171 |
Interfyl, 1 mg |
Interfyl, 1 mg |
| Q4172 |
Puraply or puraply am |
Puraply or puraply am, per square centimeter |
| Q4173 |
Palingen or palingen xplus |
Palingen or palingen xplus, per square centimeter |
| Q4174 |
Palingen or promatrx |
Palingen or promatrx, 0.36 mg per 0.25 cc |
| Q4175 |
Miroderm |
Miroderm, per square centimeter |
| Q4176 |
Neopatch or therion, 1 sq cm |
Neopatch or therion, per square centimeter |
| Q4177 |
Floweramnioflo, 0.1 cc |
Floweramnioflo, 0.1 cc |
| Q4178 |
Floweramniopatch, per sq cm |
Floweramniopatch, per square centimeter |
| Q4179 |
Flowerderm, per sq cm |
Flowerderm, per square centimeter |
| Q4180 |
Revita, per sq cm |
Revita, per square centimeter |
| Q4181 |
Amnio wound, per square cm |
Amnio wound, per square centimeter |
| Q4182 |
Transcyte, per sq centimeter |
Transcyte, per square centimeter |
| Q4183 |
Surgigraft, 1 sq cm |
Surgigraft, per square centimeter |
| Q4184 |
Cellesta or duo per sq cm |
Cellesta or cellesta duo, per square centimeter |
| Q4185 |
Cellesta flowab amnion 0.5cc |
Cellesta flowable amnion (25 mg per cc); per 0.5 cc |
| Q4186 |
Epifix 1 sq cm |
Epifix, per square centimeter |
| Q4187 |
Epicord 1 sq cm |
Epicord, per square centimeter |
| Q4188 |
Amnioarmor 1 sq cm |
Amnioarmor, per square centimeter |
| Q4189 |
Artacent ac, 1 mg |
Artacent ac, 1 mg |
| Q4190 |
Artacent ac 1 sq cm |
Artacent ac, per square centimeter |
| Q4191 |
Restorigin 1 sq cm |
Restorigin, per square centimeter |
| Q4192 |
Restorigin, 1 cc |
Restorigin, 1 cc |
| Q4193 |
Coll-e-derm 1 sq cm |
Coll-e-derm, per square centimeter |
| Q4194 |
Novachor 1 sq cm |
Novachor, per square centimeter |
| Q4195 |
Puraply 1 sq cm |
Puraply, per square centimeter |
| Q4196 |
Puraply am 1 sq cm |
Puraply am, per square centimeter |
| Q4197 |
Puraply xt 1 sq cm |
Puraply xt, per square centimeter |
| Q4198 |
Genesis amnio membrane 1sqcm |
Genesis amniotic membrane, per square centimeter |
| Q4199 |
Cygnus matrix, per sq cm |
Cygnus matrix, per square centimeter |
| Q4200 |
Skin te 1 sq cm |
Skin te, per square centimeter |
| Q4201 |
Matrion 1 sq cm |
Matrion, per square centimeter |
| Q4202 |
Keroxx (2.5g/cc), 1cc |
Keroxx (2.5g/cc), 1cc |
| Q4203 |
Derma-gide, 1 sq cm |
Derma-gide, per square centimeter |
| Q4204 |
Xwrap 1 sq cm |
Xwrap, per square centimeter |
| Q4205 |
Membrane graft or wrap sq cm |
Membrane graft or membrane wrap, per square centimeter |
| Q4206 |
Fluid flow or fluid gf 1 cc |
Fluid flow or fluid gf, 1 cc |
| Q4208 |
Novafix per sq cm |
Novafix, per square cenitmeter |
| Q4209 |
Surgraft per sq cm |
Surgraft, per square centimeter |
| Q4210 |
Axolotl graf dualgraf sq cm |
Axolotl graft or axolotl dualgraft, per square centimeter |
| Q4211 |
Amnion bio or axobio sq cm |
Amnion bio or axobiomembrane, per square centimeter |
| Q4212 |
Allogen, per cc |
Allogen, per cc |
| Q4213 |
Ascent, 0.5 mg |
Ascent, 0.5 mg |
| Q4214 |
Cellesta cord per sq cm |
Cellesta cord, per square centimeter |
| Q4215 |
Axolotl ambient, cryo 0.1 mg |
Axolotl ambient or axolotl cryo, 0.1 mg |
| Q4216 |
Artacent cord per sq cm |
Artacent cord, per square centimeter |
| Q4217 |
Woundfix biowound plus xplus |
Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter |
| Q4218 |
Surgicord per sq cm |
Surgicord, per square centimeter |
| Q4219 |
Surgigraft dual per sq cm |
Surgigraft-dual, per square centimeter |
| Q4220 |
Bellacell hd, surederm sq cm |
Bellacell hd or surederm, per square centimeter |
| Q4221 |
Amniowrap2 per sq cm |
Amniowrap2, per square centimeter |
| Q4222 |
Progenamatrix, per sq cm |
Progenamatrix, per square centimeter |
| Q4224 |
Hhf10-p per sq cm |
Human health factor 10 amniotic patch (hhf10-p), per square centimeter |
| Q4225 |
Amnio or derma tl, per sq cm |
Amniobind or dermabind tl, per square centimeter |
| Q4226 |
Myown harv prep proc sq cm |
Myown skin, includes harvesting and preparation procedures, per square centimeter |
| Q4227 |
Amniocore per sq cm |
Amniocore, per square centimeter |
| Q4228 |
Bionextpatch, per sq cm |
Bionextpatch, per square centimeter |
| Q4229 |
Cogenex amnio memb per sq cm |
Cogenex amniotic membrane, per square centimeter |
| Q4230 |
Cogenex flow amnion 0.5 cc |
Cogenex flowable amnion, per 0.5 cc |
| Q4231 |
Corplex p, per cc |
Corplex p, per cc |
| Q4232 |
Corplex, per sq cm |
Corplex, per square centimeter |
| Q4233 |
Surfactor /nudyn per 0.5 cc |
Surfactor or nudyn, per 0.5 cc |
| Q4234 |
Xcellerate, per sq cm |
Xcellerate, per square centimeter |
| Q4235 |
Amniorepair or altiply sq cm |
Amniorepair or altiply, per square centimeter |
| Q4236 |
Carepatch per sq cm |
Carepatch, per square centimeter |
| Q4237 |
Cryo-cord, per sq cm |
Cryo-cord, per square centimeter |
| Q4238 |
Derm-maxx, per sq cm |
Derm-maxx, per square centimeter |
| Q4239 |
Amnio-maxx or lite per sq cm |
Amnio-maxx or amnio-maxx lite, per square centimeter |
| Q4240 |
Corecyte topical only 0.5 cc |
Corecyte, for topical use only, per 0.5 cc |
| Q4241 |
Polycyte, topical only 0.5cc |
Polycyte, for topical use only, per 0.5 cc |
| Q4242 |
Amniocyte plus, per 0.5 cc |
Amniocyte plus, per 0.5 cc |
| Q4244 |
Procenta, per 200 mg |
Procenta, per 200 mg |
| Q4245 |
Amniotext, per cc |
Amniotext, per cc |
| Q4246 |
Coretext or protext, per cc |
Coretext or protext, per cc |
| Q4247 |
Amniotext patch, per sq cm |
Amniotext patch, per square centimeter |
| Q4248 |
Dermacyte amn mem allo sq cm |
Dermacyte amniotic membrane allograft, per square centimeter |
| Q4249 |
Amniply, per sq cm |
Amniply, for topical use only, per square centimeter |
| Q4250 |
Amnioamp-mp per sq cm |
Amnioamp-mp, per square centimeter |
| Q4251 |
Vim, per square centimeter |
Vim, per square centimeter |
| Q4252 |
Vendaje, per square centimet |
Vendaje, per square centimeter |
| Q4253 |
Zenith amniotic membrane psc |
Zenith amniotic membrane, per square centimeter |
| Q4254 |
Novafix dl per sq cm |
Novafix dl, per square centimeter |
| Q4255 |
Reguard, topical use per sq |
Reguard, for topical use only, per square centimeter |
| Q4256 |
Mlg complet, per sq cm |
Mlg-complete, per square centimeter |
| Q4257 |
Relese, per sq cm |
Relese, per square centimeter |
| Q4258 |
Enverse, per sq cm |
Enverse, per square centimeter |
| Q4259 |
Celera per sq cm |
Celera dual layer or celera dual membrane, per square centimeter |
| Q4260 |
Signature apatch, per sq cm |
Signature apatch, per square centimeter |
| Q4261 |
Tag, per square centimeter |
Tag, per square centimeter |
| Q4262 |
Dual layer impax, per sq cm |
Dual layer impax membrane, per square centimeter |
| Q4263 |
Surgraft tl, per sq cm |
Surgraft tl, per square centimeter |
| Q4264 |
Cocoon membrane, per sq cm |
Cocoon membrane, per square centimeter |
| Q4265 |
Neostim tl per sq cm |
Neostim tl, per square centimeter |
| Q4266 |
Neostim per sq cm |
Neostim membrane, per square centimeter |
| Q4267 |
Neostim dl per sq cm |
Neostim dl, per square centimeter |
| Q4268 |
Surgraft ft per sq cm |
Surgraft ft, per square centimeter |
| Q4269 |
Surgraft xt per sq cm |
Surgraft xt, per square centimeter |
| Q4270 |
Complete sl per sq cm |
Complete sl, per square centimeter |
| Q4271 |
Complete ft per sq cm |
Complete ft, per square centimeter |
| Q4272 |
Esano a, per sq cm |
Esano a, per square centimeter |
| Q4273 |
Esano aaa, per sq cm |
Esano aaa, per square centimeter |
| Q4274 |
Esano ac, per sq cm |
Esano ac, per square centimeter |
| Q4275 |
Esano aca, per sq cm |
Esano aca, per square centimeter |
| Q4276 |
Orion, per sq cm |
Orion, per square centimeter |
| Q4277 |
Woundplus e-grat, per sq cm |
Woundplus membrane or e-graft, per square centimeter |
| Q4278 |
Epieffect, per sq cm |
Epieffect, per square centimeter |
| Q4279 |
Vendaje ac, per sq cm |
Vendaje ac, per square centimeter |
| Q4280 |
Xcell amnio matrix per sq cm |
Xcell amnio matrix, per square centimeter |
| Q4281 |
Barrera slor dl per sq cm |
Barrera sl or barrera dl, per square centimeter |
| Q4282 |
Cygnus dual per sq cm |
Cygnus dual, per square centimeter |
| Q4283 |
Biovance tri or 3l, sq cm |
Biovance tri-layer or biovance 3l, per square centimeter |
| Q4284 |
Dermabind sl, per sq cm |
Dermabind sl, per square centimeter |
| Q4285 |
Nudyn dl or dl mesh pr sq cm |
Nudyn dl or nudyn dl mesh, per square centimeter |
| Q4286 |
Nudyn sl or slw, per sq cm |
Nudyn sl or nudyn slw, per square centimeter |
| Q4287 |
Dermabind dl, per sq cm |
Dermabind dl, per square centimeter |
| Q4288 |
Dermabind ch, per sq cm |
Dermabind ch, per square centimeter |
| Q4289 |
Revoshield+ amnio, per sq cm |
Revoshield + amniotic barrier, per square centimeter |
| Q4290 |
Membrane wrap hydr per sq cm |
Membrane wrap-hydro, per square centimeter |
| Q4291 |
Lamellas xt, per sq cm |
Lamellas xt, per square centimeter |
| Q4292 |
Lamellas, per sq cm |
Lamellas, per square centimeter |
| Q4293 |
Acesso dl, per sq cm |
Acesso dl, per square centimeter |
| Q4294 |
Amnio quad-core, per sq cm |
Amnio quad-core, per square centimeter |
| Q4295 |
Amnio tri-core, per sq cm |
Amnio tri-core amniotic, per square centimeter |
| Q4296 |
Rebound matrix, per sq cm |
Rebound matrix, per square centimeter |
| Q4297 |
Emerge matrix, per sq cm |
Emerge matrix, per square centimeter |
| Q4298 |
Amnicore pro, per sq cm |
Amnicore pro, per square centimeter |
| Q4299 |
Amnicore pro+, per sq cm |
Amnicore pro+, per square centimeter |
| Q4300 |
Acesso tl, per sq cm |
Acesso tl, per square centimeter |
| Q4301 |
Activate matrix, per sq cm |
Activate matrix, per square centimeter |
| Q4302 |
Complete aca, per sq cm |
Complete aca, per square centimeter |
| Q4303 |
Complete aa, per sq cm |
Complete aa, per square centimeter |
| Q4304 |
Grafix plus, per sq cm |
Grafix plus, per square centimeter |
| Q4305 |
Amer am ac tri-lay per sq cm |
American amnion ac tri-layer, per square centimeter |
| Q4306 |
Americ amnion ac per sq cm |
American amnion ac, per square centimeter |
| Q4307 |
American amnion, per sq cm |
American amnion, per square centimeter |
| Q4308 |
Sanopellis, per sq cm |
Sanopellis, per square centimeter |
| Q4309 |
Via matrix, per sq cm |
Via matrix, per square centimeter |
| Q4310 |
Procenta, per 100 mg |
Procenta, per 100 mg |
| Q4311 |
Acesso, per sq cm |
Acesso, per square centimeter |
| Q4312 |
Acesso ac, per sq cm |
Acesso ac, per square centimeter |
| Q4313 |
Dermabind fm, per sq cm |
Dermabind fm, per square centimeter |
| Q4314 |
Reeva, per sq cm |
Reeva ft, per square cenitmeter |
| Q4315 |
Regenelink amniotic mem allo |
Regenelink amniotic membrane allograft, per square centimeter |
| Q4316 |
Amchoplast, per sq cm |
Amchoplast, per square centimeter |
| Q4317 |
Vitograft, per sq cm |
Vitograft, per square centimeter |
| Q4318 |
E-graft, per sq cm |
E-graft, per square centimeter |
| Q4319 |
Sanograft, per sq cm |
Sanograft, per square centimeter |
| Q4320 |
Pellograft, per sq cm |
Pellograft, per square centimeter |
| Q4321 |
Renograft, per sq cm |
Renograft, per square centimeter |
| Q4322 |
Caregraft, per sq cm |
Caregraft, per square centimeter |
| Q4323 |
Alloply, per sq cm |
Alloply, per square centimeter |
| Q4324 |
Amniotx, per sq cm |
Amniotx, per square centimeter |
| Q4325 |
Acapatch, per sq cm |
Acapatch, per square centimeter |
| Q4326 |
Woundplus, per sq cm |
Woundplus, per square centimeter |
| Q4327 |
Duoamnion, per sq cm |
Duoamnion, per square centimeter |
| Q4328 |
Most, per sq cm |
Most, per square centimeter |
| Q4329 |
Singlay, per sq cm |
Singlay, per square centimeter |
| Q4330 |
Total, per sq cm |
Total, per square centimeter |
| Q4331 |
Axolotl graft, per sq cm |
Axolotl graft, per square centimeter |
| Q4332 |
Axolotl dualgraft, per sq cm |
Axolotl dualgraft, per square centimeter |
| Q4333 |
Ardeograft, per sq cm |
Ardeograft, per square centimeter |
| Q5 |
Recip bill arr subs md or pt |
Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
| Q5001 |
Hospice or home hlth in home |
Hospice or home health care provided in patient's home/residence |
| Q5002 |
Hospice/home hlth in asst lv |
Hospice or home health care provided in assisted living facility |
| Q5003 |
Hospice in lt/non-skilled nf |
Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) |
| Q5004 |
Hospice in snf |
Hospice care provided in skilled nursing facility (snf) |
| Q5005 |
Hospice, inpatient hospital |
Hospice care provided in inpatient hospital |
| Q5006 |
Hospice in hospice facility |
Hospice care provided in inpatient hospice facility |
| Q5007 |
Hospice in ltch |
Hospice care provided in long term care facility |
| Q5008 |
Hospice in inpatient psych |
Hospice care provided in inpatient psychiatric facility |
| Q5009 |
Hospice/home hlth, place nos |
Hospice or home health care provided in place not otherwise specified (nos) |
| Q5010 |
Hospice home care in hospice |
Hospice home care provided in a hospice facility |
| Q5101 |
Injection, zarxio |
Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram |
| Q5102 |
Inj., infliximab biosimilar |
Injection, infliximab, biosimilar, 10 mg |
| Q5103 |
Injection, inflectra |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
| Q5104 |
Injection, renflexis |
Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
| Q5105 |
Inj retacrit esrd on dialysi |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units |
| Q5106 |
Inj retacrit non-esrd use |
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units |
| Q5107 |
Inj mvasi 10 mg |
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
| Q5108 |
Injection, fulphila |
Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg |
| Q5109 |
Injection, ixifi, 10 mg |
Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg |
| Q5110 |
Nivestym |
Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram |
| Q5111 |
Injection, udenyca 0.5 mg |
Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg |
| Q5112 |
Inj ontruzant 10 mg |
Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg |
| Q5113 |
Inj herzuma 10 mg |
Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg |
| Q5114 |
Inj ogivri 10 mg |
Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg |
| Q5115 |
Inj truxima 10 mg |
Injection, rituximab-abbs, biosimilar, (truxima), 10 mg |
| Q5116 |
Inj., trazimera, 10 mg |
Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg |
| Q5117 |
Inj., kanjinti, 10 mg |
Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg |
| Q5118 |
Inj., zirabev, 10 mg |
Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg |
| Q5119 |
Inj ruxience, 10 mg |
Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg |
| Q5120 |
Inj pegfilgrastim-bmez 0.5mg |
Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg |
| Q5121 |
Inj. avsola, 10 mg |
Injection, infliximab-axxq, biosimilar, (avsola), 10 mg |
| Q5122 |
Inj, nyvepria |
Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg |
| Q5123 |
Inj. riabni, 10 mg |
Injection, rituximab-arrx, biosimilar, (riabni), 10 mg |
| Q5124 |
Inj. byooviz, 0.1 mg |
Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg |
| Q5125 |
Inj, releuko 1 mcg |
Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram |
| Q5126 |
Inj alymsys 10 mg |
Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg |
| Q5127 |
Inj, stimufend, 0.5 mg |
Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg |
| Q5128 |
Inj, cimerli, 0.1 mg |
Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg |
| Q5129 |
Inj, vegzelma, 10 mg |
Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg |
| Q5130 |
Inj, fylnetra, 0.5 mg |
Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg |
| Q5131 |
Inj, idacio, 20 mg |
Injection, adalimumab-aacf (idacio), biosimilar, 20 mg |
| Q5132 |
Inj, abrilada, 10 mg |
Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg |
| Q5133 |
Inj, tofidence, 1 mg |
Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg |
| Q5134 |
Inj, tyruko, 1 mg |
Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg |
| Q5137 |
Inj, wezlana, sub cu, 1 mg |
Injection, ustekinumab-auub (wezlana), biosimilar, subcutaneous, 1 mg |
| Q5138 |
Inj, wezlana, iv, 1 mg |
Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg |
| Q6 |
Fee/time comp subst md or pt |
Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
| Q7 |
One class a finding |
One class a finding |
| Q8 |
Two class b findings |
Two class b findings |
| Q9 |
1 class b & 2 class c fndngs |
One class b and two class c findings |
| Q9001 |
Chaplain assessment |
Assessment by chaplain services |
| Q9002 |
Chaplain counsel individu |
Counseling, individual, by chaplain services |
| Q9003 |
Chaplain counsel group |
Counseling, group, by chaplain services |
| Q9004 |
Va whole health partner serv |
Department of veterans affairs whole health partner services |
| Q9950 |
Inj sulf hexa lipid microsph |
Injection, sulfur hexafluoride lipid microspheres, per ml |
| Q9951 |
Locm >= 400 mg/ml iodine,1ml |
Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| Q9953 |
Inj fe-based mr contrast,1ml |
Injection, iron-based magnetic resonance contrast agent, per ml |
| Q9954 |
Oral mr contrast, 100 ml |
Oral magnetic resonance contrast agent, per 100 ml |
| Q9955 |
Inj perflexane lip micros,ml |
Injection, perflexane lipid microspheres, per ml |
| Q9956 |
Inj octafluoropropane mic,ml |
Injection, octafluoropropane microspheres, per ml |
| Q9957 |
Inj perflutren lip micros,ml |
Injection, perflutren lipid microspheres, per ml |
| Q9958 |
Hocm <=149 mg/ml iodine, 1ml |
High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
| Q9959 |
Hocm 150-199mg/ml iodine,1ml |
High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml |
| Q9960 |
Hocm 200-249mg/ml iodine,1ml |
High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml |
| Q9961 |
Hocm 250-299mg/ml iodine,1ml |
High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml |
| Q9962 |
Hocm 300-349mg/ml iodine,1ml |
High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml |
| Q9963 |
Hocm 350-399mg/ml iodine,1ml |
High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
| Q9964 |
Hocm>= 400mg/ml iodine, 1ml |
High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
| Q9968 |
Visualization adjunct |
Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg |
| Q9969 |
Non-heu tc-99m add-on/dose |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
| Q9970 |
Inj ferric carboxymaltos 1mg |
Injection, ferric carboxymaltose, 1mg |
| Q9972 |
Epoetin beta esrd use |
Injection, epoetin beta, 1 microgram, (for esrd on dialysis) |
| Q9973 |
Epoetin beta non esrd |
Injection, epoetin beta, 1 microgram, (non-esrd use) |
| Q9974 |
Morphine epidural/intratheca |
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg |
| Q9975 |
Factor viii fc fusion recomb |
Injection, factor viii fc fusion protein (recombinant), per iu |
| Q9976 |
Inj ferric pyrophosphate cit |
Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron |
| Q9977 |
Compounded drug noc |
Compounded drug, not otherwise classified |
| Q9978 |
Netupitant palonosetron oral |
Netupitant 300 mg and palonosetron 0.5 mg |
| Q9979 |
Injection, alemtuzumab |
Injection, alemtuzumab, 1 mg |
| Q9980 |
Genvisc, inj, 1mg |
Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg |
| Q9981 |
Rolapitant, oral, 1mg |
Rolapitant, oral, 1 mg |
| Q9982 |
Flutemetamol f18 diagnostic |
Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries |
| Q9983 |
Florbetaben f18 diagnostic |
Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries |
| Q9984 |
Kyleena, 19.5 mg |
Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg |
| Q9985 |
Inj hydroxyprogst capoat nos |
Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg |
| Q9986 |
Makena, 10 mg |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
| Q9987 |
Pathogen test for platelets |
Pathogen(s) test for platelets |
| Q9988 |
Platelets, pathogen reduced |
Platelets, pheresis, pathogen-reduced, each unit |
| Q9989 |
Ustekinumab, iv inject,1 mg |
Ustekinumab, for intravenous injection, 1 mg |
| Q9991 |
Buprenorph xr 100 mg or less |
Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg |
| Q9992 |
Buprenorphine xr over 100 mg |
Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
| Q9993 |
Inj., triamcinolone ext rel |
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg |
| Q9994 |
Enzyme cartridge enteral nut |
In-line cartridge containing digestive enzyme(s) for enteral feeding, each |
| Q9995 |
Inj., emicizumab-kxwh 0.5 mg |
Injection, emicizumab-kxwh, 0.5 mg |
| QA |
Avg sta day/night o2 < 1 lpm |
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (lpm) |
| QB |
Avg day/nite o2 > 4 lpm/port |
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed |
| QC |
Single channel monitoring |
Single channel monitoring |
| QD |
Rcrdg/strg in sld st memory |
Recording and storage in solid state memory by a digital recorder |
| QE |
Stationary o2 @ rest <1 lpm |
Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm) |
| QF |
Station o2 @ rest >4lpm/port |
Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed |
| QG |
Station o2 @ rest > 4 lpm |
Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) |
| QH |
Oxygen cnsrvg dvc w del sys |
Oxygen conserving device is being used with an oxygen delivery system |
| QJ |
Patient in state/locl custod |
Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) |
| QK |
Med dir 2-4 cncrnt anes proc |
Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals |
| QL |
Patient died after amb call |
Patient pronounced dead after ambulance called |
| QM |
Ambulance arr by provider |
Ambulance service provided under arrangement by a provider of services |
| QN |
Ambulance furn by provider |
Ambulance service furnished directly by a provider of services |
| QP |
Individually ordered lab tst |
Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a cpt-recognized panel other than automated profile codes 80002-80019, g0058, g0059, and g0060. |
| QQ |
Qualified cdsm consulted |
Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional |
| QR |
Avg sta day/night o2 > 4 lpm |
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm) |
| QS |
Monitored anesthesia care |
Monitored anesthesia care service |
| QT |
Rcrdg/strg tape analog recdr |
Recording and storage on tape by an analog tape recorder |
| QW |
Clia waived test |
Clia waived test |
| QX |
Crna svc w/ md med direction |
Crna service: with medical direction by a physician |
| QY |
Medically directed crna |
Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist |
| QZ |
Crna svc w/o med dir by md |
Crna service: without medical direction by a physician |