Q0000–Q9999: Miscellaneous Services

HCPC SEQNUM RECID LONG DESCRIPTION SHORT DESCRIPTION
Q0035 0010 3 Cardiokymography Cardiokymography
Q0081 0010 3 Infusion therapy, using other than chemotherapeutic drugs, per visit Infusion ther other than che
Q0083 0010 3 Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit Chemo by other than infusion
Q0084 0010 3 Chemotherapy administration by infusion technique only, per visit Chemotherapy by infusion
Q0085 0010 3 Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit Chemo by both infusion and o
Q0091 0010 3 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory Obtaining screen pap smear
Q0092 0010 3 Set-up portable x-ray equipment Set up port xray equipment
Q0111 0010 3 Wet mounts, including preparations of vaginal, cervical or skin specimens Wet mounts/ w preparations
Q0112 0010 3 All potassium hydroxide (koh) preparations Potassium hydroxide preps
Q0113 0010 3 Pinworm examinations Pinworm examinations
Q0114 0010 3 Fern test Fern test
Q0115 0010 3 Post-coital direct, qualitative examinations of vaginal or cervical mucous Post-coital mucous exam
Q0138 0010 3 Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) Ferumoxytol, non-esrd
Q0139 0010 3 Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis) Ferumoxytol, esrd use
Q0144 0010 3 Azithromycin dihydrate, oral, capsules/powder, 1 gram Azithromycin dihydrate, oral
Q0161 0010 3 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 Chlorpromazine hcl 5mg oral
Q0162 0010 3 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 Ondansetron oral
Q0163 0010 3 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 Diphenhydramine hcl 50mg
Q0164 0010 3 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 Prochlorperazine maleate 5mg
Q0166 0010 3 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 Granisetron hcl 1 mg oral
Q0167 0010 3 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 Dronabinol 2.5mg oral
Q0169 0010 3 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 Promethazine hcl 12.5mg oral
Q0173 0010 3 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 Trimethobenzamide hcl 250mg
Q0174 0010 3 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 Thiethylperazine maleate10mg
Q0175 0010 3 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 Perphenazine 4mg oral
Q0177 0010 3 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 Hydroxyzine pamoate 25mg
Q0180 0010 3 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 Dolasetron mesylate oral
Q0181 0010 3 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 Unspecified oral anti-emetic
Q0477 0010 3 Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only Pwr module pt cable lvad rpl
Q0478 0010 3 Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type Power adapter, combo vad
Q0479 0010 3 Power module for use with electric or electric/pneumatic ventricular assist device, replacement only Power module combo vad, rep
Q0480 0010 3 Driver for use with pneumatic ventricular assist device, replacement only Driver pneumatic vad, rep
Q0481 0010 3 Microprocessor control unit for use with electric ventricular assist device, replacement only Microprcsr cu elec vad, rep
Q0482 0010 3 Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only Microprcsr cu combo vad, rep
Q0483 0010 3 Monitor/display module for use with electric ventricular assist device, replacement only Monitor elec vad, rep
Q0484 0010 3 Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only Monitor elec or comb vad rep
Q0485 0010 3 Monitor control cable for use with electric ventricular assist device, replacement only Monitor cable elec vad, rep
Q0486 0010 3 Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only Mon cable elec/pneum vad rep
Q0487 0010 3 Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only Leads any type vad, rep only
Q0488 0010 3 Power pack base for use with electric ventricular assist device, replacement only Pwr pack base elec vad, rep
Q0489 0010 3 Power pack base for use with electric/pneumatic ventricular assist device, replacement only Pwr pck base combo vad, rep
Q0490 0010 3 Emergency power source for use with electric ventricular assist device, replacement only Emr pwr source elec vad, rep
Q0491 0010 3 Emergency power source for use with electric/pneumatic ventricular assist device, replacement only Emr pwr source combo vad rep
Q0492 0010 3 Emergency power supply cable for use with electric ventricular assist device, replacement only Emr pwr cbl elec vad, rep
Q0493 0010 3 Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only Emr pwr cbl combo vad, rep
Q0494 0010 3 Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only Emr hd pmp elec/combo, rep
Q0495 0010 3 Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only Charger elec/combo vad, rep
Q0496 0010 3 Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only Battery elec/combo vad, rep
Q0497 0010 3 Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only Bat clps elec/comb vad, rep
Q0498 0010 3 Holster for use with electric or electric/pneumatic ventricular assist device, replacement only Holster elec/combo vad, rep
Q0499 0010 3 Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only Belt/vest elec/combo vad rep
Q0500 0010 3 Filters for use with electric or electric/pneumatic ventricular assist device, replacement only Filters elec/combo vad, rep
Q0501 0010 3 Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only Shwr cov elec/combo vad, rep
Q0502 0010 3 Mobility cart for pneumatic ventricular assist device, replacement only Mobility cart pneum vad, rep
Q0503 0010 3 Battery for pneumatic ventricular assist device, replacement only, each Battery pneum vad replacemnt
Q0504 0010 3 Power adapter for pneumatic ventricular assist device, replacement only, vehicle type Pwr adpt pneum vad, rep veh
Q0506 0010 3 Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only Lith-ion batt elec/pneum vad
Q0507 0010 3 Miscellaneous supply or accessory for use with an external ventricular assist device Misc sup/acc ext vad
Q0508 0010 3 Miscellaneous supply or accessory for use with an implanted ventricular assist device Mis sup/acc imp vad
Q0509 0010 3 Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a Mis sup/ac imp vad nopay med
Q0510 0010 3 Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant Dispens fee immunosupressive
Q0511 0010 3 Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period Sup fee antiem,antica,immuno
Q0512 0010 3 Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period Px sup fee anti-can sub pres
Q0513 0010 3 Pharmacy dispensing fee for inhalation drug(s); per 30 days Disp fee inhal drugs/30 days
Q0514 0010 3 Pharmacy dispensing fee for inhalation drug(s); per 90 days Disp fee inhal drugs/90 days
Q0515 0010 3 Injection, sermorelin acetate, 1 microgram Sermorelin acetate injection
Q1004 0010 3 New technology intraocular lens category 4 as defined in federal register notice Ntiol category 4
Q1005 0010 3 New technology intraocular lens category 5 as defined in federal register notice Ntiol category 5
Q2004 0010 3 Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml Bladder calculi irrig sol
Q2009 0010 3 Injection, fosphenytoin, 50 mg phenytoin equivalent Fosphenytoin inj pe
Q2017 0010 3 Injection, teniposide, 50 mg Teniposide, 50 mg
Q2026 0010 3 Injection, radiesse, 0.1 ml Radiesse injection
Q2028 0010 3 Injection, sculptra, 0.5 mg Inj, sculptra, 0.5mg
Q2034 0010 3 Influenza virus vaccine, split virus, for intramuscular use (agriflu) Agriflu vaccine
Q2035 0010 3 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Afluria vacc, 3 yrs & >, im
Q2036 0010 3 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) Flulaval vacc, 3 yrs & >, im
Q2037 0010 3 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) Fluvirin vacc, 3 yrs & >, im
Q2038 0010 3 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) Fluzone vacc, 3 yrs & >, im
Q2039 0010 3 Influenza virus vaccine, not otherwise specified Influenza virus vaccine, nos
Q2040 0010 3 Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion Tisagenlecleucel car-pos t
Q2041 0010 3 Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose Axicabtagene ciloleucel car+
Q2042 0010 3 Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose Tisagenlecleucel car-pos t
Q2043 0010 3 Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion Sipuleucel-t auto cd54+
Q2049 0010 3 Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg Imported lipodox inj
Q2050 0010 3 Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg Doxorubicin inj 10mg
Q2052 0010 3 Services, supplies and accessories used in the home under the medicare intravenous immune globulin (ivig) demonstration Ivig demo, services/supplies
Q3001 0010 3 Radioelements for brachytherapy, any type, each Brachytherapy radioelements
Q3014 0010 3 Telehealth originating site facility fee Telehealth facility fee
Q3027 0010 3 Injection, interferon beta-1a, 1 mcg for intramuscular use Inj beta interferon im 1 mcg
Q3028 0010 3 Injection, interferon beta-1a, 1 mcg for subcutaneous use Inj beta interferon sq 1 mcg
Q3031 0010 3 Collagen skin test Collagen skin test
Q4001 0010 3 Casting supplies, body cast adult, with or without head, plaster Cast sup body cast plaster
Q4002 0010 3 Cast supplies, body cast adult, with or without head, fiberglass Cast sup body cast fiberglas
Q4003 0010 3 Cast supplies, shoulder cast, adult (11 years +), plaster Cast sup shoulder cast plstr
Q4004 0010 3 Cast supplies, shoulder cast, adult (11 years +), fiberglass Cast sup shoulder cast fbrgl
Q4005 0010 3 Cast supplies, long arm cast, adult (11 years +), plaster Cast sup long arm adult plst
Q4006 0010 3 Cast supplies, long arm cast, adult (11 years +), fiberglass Cast sup long arm adult fbrg
Q4007 0010 3 Cast supplies, long arm cast, pediatric (0-10 years), plaster Cast sup long arm ped plster
Q4008 0010 3 Cast supplies, long arm cast, pediatric (0-10 years), fiberglass Cast sup long arm ped fbrgls
Q4009 0010 3 Cast supplies, short arm cast, adult (11 years +), plaster Cast sup sht arm adult plstr
Q4010 0010 3 Cast supplies, short arm cast, adult (11 years +), fiberglass Cast sup sht arm adult fbrgl
Q4011 0010 3 Cast supplies, short arm cast, pediatric (0-10 years), plaster Cast sup sht arm ped plaster
Q4012 0010 3 Cast supplies, short arm cast, pediatric (0-10 years), fiberglass Cast sup sht arm ped fbrglas
Q4013 0010 3 Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster Cast sup gauntlet plaster
Q4014 0010 3 Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass Cast sup gauntlet fiberglass
Q4015 0010 3 Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster Cast sup gauntlet ped plster
Q4016 0010 3 Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass Cast sup gauntlet ped fbrgls
Q4017 0010 3 Cast supplies, long arm splint, adult (11 years +), plaster Cast sup lng arm splint plst
Q4018 0010 3 Cast supplies, long arm splint, adult (11 years +), fiberglass Cast sup lng arm splint fbrg
Q4019 0010 3 Cast supplies, long arm splint, pediatric (0-10 years), plaster Cast sup lng arm splnt ped p
Q4020 0010 3 Cast supplies, long arm splint, pediatric (0-10 years), fiberglass Cast sup lng arm splnt ped f
Q4021 0010 3 Cast supplies, short arm splint, adult (11 years +), plaster Cast sup sht arm splint plst
Q4022 0010 3 Cast supplies, short arm splint, adult (11 years +), fiberglass Cast sup sht arm splint fbrg
Q4023 0010 3 Cast supplies, short arm splint, pediatric (0-10 years), plaster Cast sup sht arm splnt ped p
Q4024 0010 3 Cast supplies, short arm splint, pediatric (0-10 years), fiberglass Cast sup sht arm splnt ped f
Q4025 0010 3 Cast supplies, hip spica (one or both legs), adult (11 years +), plaster Cast sup hip spica plaster
Q4026 0010 3 Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass Cast sup hip spica fiberglas
Q4027 0010 3 Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster Cast sup hip spica ped plstr
Q4028 0010 3 Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass Cast sup hip spica ped fbrgl
Q4029 0010 3 Cast supplies, long leg cast, adult (11 years +), plaster Cast sup long leg plaster
Q4030 0010 3 Cast supplies, long leg cast, adult (11 years +), fiberglass Cast sup long leg fiberglass
Q4031 0010 3 Cast supplies, long leg cast, pediatric (0-10 years), plaster Cast sup lng leg ped plaster
Q4032 0010 3 Cast supplies, long leg cast, pediatric (0-10 years), fiberglass Cast sup lng leg ped fbrgls
Q4033 0010 3 Cast supplies, long leg cylinder cast, adult (11 years +), plaster Cast sup lng leg cylinder pl
Q4034 0010 3 Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass Cast sup lng leg cylinder fb
Q4035 0010 3 Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster Cast sup lngleg cylndr ped p
Q4036 0010 3 Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass Cast sup lngleg cylndr ped f
Q4037 0010 3 Cast supplies, short leg cast, adult (11 years +), plaster Cast sup shrt leg plaster
Q4038 0010 3 Cast supplies, short leg cast, adult (11 years +), fiberglass Cast sup shrt leg fiberglass
Q4039 0010 3 Cast supplies, short leg cast, pediatric (0-10 years), plaster Cast sup shrt leg ped plster
Q4040 0010 3 Cast supplies, short leg cast, pediatric (0-10 years), fiberglass Cast sup shrt leg ped fbrgls
Q4041 0010 3 Cast supplies, long leg splint, adult (11 years +), plaster Cast sup lng leg splnt plstr
Q4042 0010 3 Cast supplies, long leg splint, adult (11 years +), fiberglass Cast sup lng leg splnt fbrgl
Q4043 0010 3 Cast supplies, long leg splint, pediatric (0-10 years), plaster Cast sup lng leg splnt ped p
Q4044 0010 3 Cast supplies, long leg splint, pediatric (0-10 years), fiberglass Cast sup lng leg splnt ped f
Q4045 0010 3 Cast supplies, short leg splint, adult (11 years +), plaster Cast sup sht leg splnt plstr
Q4046 0010 3 Cast supplies, short leg splint, adult (11 years +), fiberglass Cast sup sht leg splnt fbrgl
Q4047 0010 3 Cast supplies, short leg splint, pediatric (0-10 years), plaster Cast sup sht leg splnt ped p
Q4048 0010 3 Cast supplies, short leg splint, pediatric (0-10 years), fiberglass Cast sup sht leg splnt ped f
Q4049 0010 3 Finger splint, static Finger splint, static
Q4050 0010 3 Cast supplies, for unlisted types and materials of casts Cast supplies unlisted
Q4051 0010 3 Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) Splint supplies misc
Q4074 0010 3 Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms Iloprost non-comp unit dose
Q4081 0010 3 Injection, epoetin alfa, 100 units (for esrd on dialysis) Epoetin alfa, 100 units esrd
Q4082 0010 3 Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap) Drug/bio noc part b drug cap
Q4100 0010 3 Skin substitute, not otherwise specified Skin substitute, nos
Q4101 0010 3 Apligraf, per square centimeter Apligraf
Q4102 0010 3 Oasis wound matrix, per square centimeter Oasis wound matrix
Q4103 0010 3 Oasis burn matrix, per square centimeter Oasis burn matrix
Q4104 0010 3 Integra bilayer matrix wound dressing (bmwd), per square centimeter Integra bmwd
Q4105 0010 3 Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter Integra drt or omnigraft
Q4106 0010 3 Dermagraft, per square centimeter Dermagraft
Q4107 0010 3 Graftjacket, per square centimeter Graftjacket
Q4108 0010 3 Integra matrix, per square centimeter Integra matrix
Q4110 0010 3 Primatrix, per square centimeter Primatrix
Q4111 0010 3 Gammagraft, per square centimeter Gammagraft
Q4112 0010 3 Cymetra, injectable, 1 cc Cymetra injectable
Q4113 0010 3 Graftjacket xpress, injectable, 1 cc Graftjacket xpress
Q4114 0010 3 Integra flowable wound matrix, injectable, 1 cc Integra flowable wound matri
Q4115 0010 3 Alloskin, per square centimeter Alloskin
Q4116 0010 3 Alloderm, per square centimeter Alloderm
Q4117 0010 3 Hyalomatrix, per square centimeter Hyalomatrix
Q4118 0010 3 Matristem micromatrix, 1 mg Matristem micromatrix
Q4119 0010 3 Matristem wound matrix, per square centimeter Matristem wound matrix
Q4120 0010 3 Matristem burn matrix, per square centimeter Matristem burn matrix
Q4121 0010 3 Theraskin, per square centimeter Theraskin
Q4122 0010 3 Dermacell, dermacell awm or dermacell awm porous, per square centimeter Dermacell, awm, porous sq cm
Q4123 0010 3 Alloskin rt, per square centimeter Alloskin
Q4124 0010 3 Oasis ultra tri-layer wound matrix, per square centimeter Oasis tri-layer wound matrix
Q4125 0010 3 Arthroflex, per square centimeter Arthroflex
Q4126 0010 3 Memoderm, dermaspan, tranzgraft or integuply, per square centimeter Memoderm/derma/tranz/integup
Q4127 0010 3 Talymed, per square centimeter Talymed
Q4128 0010 3 Flex hd, allopatch hd, or matrix hd, per square centimeter Flexhd/allopatchhd/matrixhd
Q4129 0010 3 Unite biomatrix, per square centimeter Unite biomatrix
Q4130 0010 3 Strattice tm, per square centimeter Strattice tm
Q4131 0010 3 Epifix or epicord, per square centimeter Epifix or epicord
Q4132 0010 3 Grafix core and grafixpl core, per square centimeter Grafix core, grafixpl core
Q4133 0010 3 Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter Grafix stravix prime pl sqcm
Q4134 0010 3 Hmatrix, per square centimeter Hmatrix
Q4135 0010 3 Mediskin, per square centimeter Mediskin
Q4136 0010 3 Ez-derm, per square centimeter Ezderm
Q4137 0010 3 Amnioexcel, amnioexcel plus or biodexcel, per square centimeter Amnioexcel biodexcel 1sq cm
Q4138 0010 3 Biodfence dryflex, per square centimeter Biodfence dryflex, 1cm
Q4139 0010 3 Amniomatrix or biodmatrix, injectable, 1 cc Amnio or biodmatrix, inj 1cc
Q4140 0010 3 Biodfence, per square centimeter Biodfence 1cm
Q4141 0010 3 Alloskin ac, per square centimeter Alloskin ac, 1 cm
Q4142 0010 3 Xcm biologic tissue matrix, per square centimeter Xcm biologic tiss matrix 1cm
Q4143 0010 3 Repriza, per square centimeter Repriza, 1cm
Q4145 0010 3 Epifix, injectable, 1 mg Epifix, inj, 1mg
Q4146 0010 3 Tensix, per square centimeter Tensix, 1cm
Q4147 0010 3 Architect, architect px, or architect fx, extracellular matrix, per square centimeter Architect ecm px fx 1 sq cm
Q4148 0010 3 Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter Neox neox rt or clarix cord
Q4149 0010 3 Excellagen, 0.1 cc Excellagen, 0.1 cc
Q4150 0010 3 Allowrap ds or dry, per square centimeter Allowrap ds or dry 1 sq cm
Q4151 0010 3 Amnioband or guardian, per square centimeter Amnioband, guardian 1 sq cm
Q4152 0010 3 Dermapure, per square centimeter Dermapure 1 square cm
Q4153 0010 3 Dermavest and plurivest, per square centimeter Dermavest, plurivest sq cm
Q4154 0010 3 Biovance, per square centimeter Biovance 1 square cm
Q4155 0010 3 Neoxflo or clarixflo, 1 mg Neoxflo or clarixflo 1 mg
Q4156 0010 3 Neox 100 or clarix 100, per square centimeter Neox 100 or clarix 100
Q4157 0010 3 Revitalon, per square centimeter Revitalon 1 square cm
Q4158 0010 3 Kerecis omega3, per square centimeter Kerecis omega3, per sq cm
Q4159 0010 3 Affinity, per square centimeter Affinity1 square cm
Q4160 0010 3 Nushield, per square centimeter Nushield 1 square cm
Q4161 0010 3 Bio-connekt wound matrix, per square centimeter Bio-connekt per square cm
Q4162 0010 3 Woundex flow, bioskin flow, 0.5 cc Wndex flw, bioskn flw, 0.5cc
Q4163 0010 3 Woundex, bioskin, per square centimeter Woundex, bioskin, per sq cm
Q4164 0010 3 Helicoll, per square centimeter Helicoll, per square cm
Q4165 0010 3 Keramatrix or kerasorb, per square centimeter Keramatrix, kerasorb sq cm
Q4166 0010 3 Cytal, per square centimeter Cytal, per square centimeter
Q4167 0010 3 Truskin, per square centimeter Truskin, per sq centimeter
Q4168 0010 3 Amnioband, 1 mg Amnioband, 1 mg
Q4169 0010 3 Artacent wound, per square centimeter Artacent wound, per sq cm
Q4170 0010 3 Cygnus, per square centimeter Cygnus, per sq cm
Q4171 0010 3 Interfyl, 1 mg Interfyl, 1 mg
Q4172 0010 3 Puraply or puraply am, per square centimeter Puraply or puraply am
Q4173 0010 3 Palingen or palingen xplus, per square centimeter Palingen or palingen xplus
Q4174 0010 3 Palingen or promatrx, 0.36 mg per 0.25 cc Palingen or promatrx
Q4175 0010 3 Miroderm, per square centimeter Miroderm
Q4176 0010 3 Neopatch, per square centimeter Neopatch, per sq centimeter
Q4177 0010 3 Floweramnioflo, 0.1 cc Floweramnioflo, 0.1 cc
Q4178 0010 3 Floweramniopatch, per square centimeter Floweramniopatch, per sq cm
Q4179 0010 3 Flowerderm, per square centimeter Flowerderm, per sq cm
Q4180 0010 3 Revita, per square centimeter Revita, per sq cm
Q4181 0010 3 Amnio wound, per square centimeter Amnio wound, per square cm
Q4182 0010 3 Transcyte, per square centimeter Transcyte, per sq centimeter
Q4183 0010 3 Surgigraft, per square centimeter Surgigraft, 1 sq cm
Q4184 0010 3 Cellesta or cellesta duo, per square centimeter Cellesta or duo per sq cm
Q4185 0010 3 Cellesta flowable amnion (25 mg per cc); per 0.5 cc Cellesta flowab amnion 0.5cc
Q4186 0010 3 Epifix, per square centimeter Epifix 1 sq cm
Q4187 0010 3 Epicord, per square centimeter Epicord 1 sq cm
Q4188 0010 3 Amnioarmor, per square centimeter Amnioarmor 1 sq cm
Q4189 0010 3 Artacent ac, 1 mg Artacent ac, 1 mg
Q4190 0010 3 Artacent ac, per square centimeter Artacent ac 1 sq cm
Q4191 0010 3 Restorigin, per square centimeter Restorigin 1 sq cm
Q4192 0010 3 Restorigin, 1 cc Restorigin, 1 cc
Q4193 0010 3 Coll-e-derm, per square centimeter Coll-e-derm 1 sq cm
Q4194 0010 3 Novachor, per square centimeter Novachor 1 sq cm
Q4195 0010 3 Puraply, per square centimeter Puraply 1 sq cm
Q4196 0010 3 Puraply am, per square centimeter Puraply am 1 sq cm
Q4197 0010 3 Puraply xt, per square centimeter Puraply xt 1 sq cm
Q4198 0010 3 Genesis amniotic membrane, per square centimeter Genesis amnio membrane 1sqcm
Q4200 0010 3 Skin te, per square centimeter Skin te 1 sq cm
Q4201 0010 3 Matrion, per square centimeter Matrion 1 sq cm
Q4202 0010 3 Keroxx (2.5g/cc), 1cc Keroxx (2.5g/cc), 1cc
Q4203 0010 3 Derma-gide, per square centimeter Derma-gide, 1 sq cm
Q4204 0010 3 Xwrap, per square centimeter Xwrap 1 sq cm
Q4205 0010 3 Membrane graft or membrane wrap, per square centimeter Membrane graft or wrap sq cm
Q4206 0010 3 Fluid flow or fluid gf, 1 cc Fluid flow or fluid gf 1 cc
Q4208 0010 3 Novafix, per square cenitmeter Novafix per sq cm
Q4209 0010 3 Surgraft, per square centimeter Surgraft per sq cm
Q4210 0010 3 Axolotl graft or axolotl dualgraft, per square centimeter Axolotl graf dualgraf sq cm
Q4211 0010 3 Amnion bio or axobiomembrane, per square centimeter Amnion bio or axobio sq cm
Q4212 0010 3 Allogen, per cc Allogen, per cc
Q4213 0010 3 Ascent, 0.5 mg Ascent, 0.5 mg
Q4214 0010 3 Cellesta cord, per square centimeter Cellesta cord per sq cm
Q4215 0010 3 Axolotl ambient or axolotl cryo, 0.1 mg Axolotl ambient, cryo 0.1 mg
Q4216 0010 3 Artacent cord, per square centimeter Artacent cord per sq cm
Q4217 0010 3 Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter Woundfix biowound plus xplus
Q4218 0010 3 Surgicord, per square centimeter Surgicord per sq cm
Q4219 0010 3 Surgigraft-dual, per square centimeter Surgigraft dual per sq cm
Q4220 0010 3 Bellacell hd or surederm, per square centimeter Bellacell hd, surederm sq cm
Q4221 0010 3 Amniowrap2, per square centimeter Amniowrap2 per sq cm
Q4222 0010 3 Progenamatrix, per square centimeter Progenamatrix, per sq cm
Q4226 0010 3 Myown skin, includes harvesting and preparation procedures, per square centimeter Myown harv prep proc sq cm
Q5001 0010 3 Hospice or home health care provided in patient’s home/residence Hospice or home hlth in home
Q5002 0010 3 Hospice or home health care provided in assisted living facility Hospice/home hlth in asst lv
Q5003 0010 3 Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) Hospice in lt/non-skilled nf
Q5004 0010 3 Hospice care provided in skilled nursing facility (snf) Hospice in snf
Q5005 0010 3 Hospice care provided in inpatient hospital Hospice, inpatient hospital
Q5006 0010 3 Hospice care provided in inpatient hospice facility Hospice in hospice facility
Q5007 0010 3 Hospice care provided in long term care facility Hospice in ltch
Q5008 0010 3 Hospice care provided in inpatient psychiatric facility Hospice in inpatient psych
Q5009 0010 3 Hospice or home health care provided in place not otherwise specified (nos) Hospice/home hlth, place nos
Q5010 0010 3 Hospice home care provided in a hospice facility Hospice home care in hospice
Q5101 0010 3 Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram Injection, zarxio
Q5102 0010 3 Injection, infliximab, biosimilar, 10 mg Inj., infliximab biosimilar
Q5103 0010 3 Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg Injection, inflectra
Q5104 0010 3 Injection, infliximab-abda, biosimilar, (renflexis), 10 mg Injection, renflexis
Q5105 0010 3 Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units Inj retacrit esrd on dialysi
Q5106 0010 3 Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units Inj retacrit non-esrd use
Q5107 0010 3 Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg Inj mvasi 10 mg
Q5108 0010 3 Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg Injection, fulphila
Q5109 0010 3 Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg Injection, ixifi, 10 mg
Q5110 0010 3 Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram Nivestym
Q5111 0010 3 Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg Injection, udenyca 0.5 mg
Q5112 0010 3 Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg Inj ontruzant 10 mg
Q5113 0010 3 Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg Inj herzuma 10 mg
Q5114 0010 3 Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg Inj ogivri 10 mg
Q5115 0010 3 Injection, rituximab-abbs, biosimilar, (truxima), 10 mg Inj truxima 10 mg
Q5116 0010 3 Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg Inj., trazimera, 10 mg
Q5117 0010 3 Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg Inj., kanjinti, 10 mg
Q5118 0010 3 Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg Inj., zirabev, 10 mg
Q9950 0010 3 Injection, sulfur hexafluoride lipid microspheres, per ml Inj sulf hexa lipid microsph
Q9951 0010 3 Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml Locm >= 400 mg/ml iodine,1ml
Q9953 0010 3 Injection, iron-based magnetic resonance contrast agent, per ml Inj fe-based mr contrast,1ml
Q9954 0010 3 Oral magnetic resonance contrast agent, per 100 ml Oral mr contrast, 100 ml
Q9955 0010 3 Injection, perflexane lipid microspheres, per ml Inj perflexane lip micros,ml
Q9956 0010 3 Injection, octafluoropropane microspheres, per ml Inj octafluoropropane mic,ml
Q9957 0010 3 Injection, perflutren lipid microspheres, per ml Inj perflutren lip micros,ml
Q9958 0010 3 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml Hocm <=149 mg/ml iodine, 1ml
Q9959 0010 3 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml Hocm 150-199mg/ml iodine,1ml
Q9960 0010 3 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml Hocm 200-249mg/ml iodine,1ml
Q9961 0010 3 High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml Hocm 250-299mg/ml iodine,1ml
Q9962 0010 3 High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml Hocm 300-349mg/ml iodine,1ml
Q9963 0010 3 High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml Hocm 350-399mg/ml iodine,1ml
Q9964 0010 3 High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml Hocm>= 400mg/ml iodine, 1ml
Q9965 0010 3 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml Locm 100-199mg/ml iodine,1ml
Q9966 0010 3 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml Locm 200-299mg/ml iodine,1ml
Q9967 0010 3 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml Locm 300-399mg/ml iodine,1ml
Q9968 0010 3 Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg Visualization adjunct
Q9969 0010 3 Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose Non-heu tc-99m add-on/dose
Q9970 0010 3 Injection, ferric carboxymaltose, 1mg Inj ferric carboxymaltos 1mg
Q9972 0010 3 Injection, epoetin beta, 1 microgram, (for esrd on dialysis) Epoetin beta esrd use
Q9973 0010 3 Injection, epoetin beta, 1 microgram, (non-esrd use) Epoetin beta non esrd
Q9974 0010 3 Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg Morphine epidural/intratheca
Q9975 0010 3 Injection, factor viii fc fusion protein (recombinant), per iu Factor viii fc fusion recomb
Q9976 0010 3 Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron Inj ferric pyrophosphate cit
Q9977 0010 3 Compounded drug, not otherwise classified Compounded drug noc
Q9978 0010 3 Netupitant 300 mg and palonosetron 0.5 mg Netupitant palonosetron oral
Q9979 0010 3 Injection, alemtuzumab, 1 mg Injection, alemtuzumab
Q9980 0010 3 Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg Genvisc, inj, 1mg
Q9981 0010 3 Rolapitant, oral, 1 mg Rolapitant, oral, 1mg
Q9982 0010 3 Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries Flutemetamol f18 diagnostic
Q9983 0010 3 Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries Florbetaben f18 diagnostic
Q9984 0010 3 Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg Kyleena, 19.5 mg
Q9985 0010 3 Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg Inj hydroxyprogst capoat nos
Q9986 0010 3 Injection, hydroxyprogesterone caproate, (makena), 10 mg Makena, 10 mg
Q9987 0010 3 Pathogen(s) test for platelets Pathogen test for platelets
Q9988 0010 3 Platelets, pheresis, pathogen-reduced, each unit Platelets, pathogen reduced
Q9989 0010 3 Ustekinumab, for intravenous injection, 1 mg Ustekinumab, iv inject,1 mg
Q9991 0010 3 Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg Buprenorph xr 100 mg or less
Q9992 0010 3 Injection, buprenorphine extended-release (sublocade), greater than 100 mg Buprenorphine xr over 100 mg
Q9993 0010 3 Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg Inj., triamcinolone ext rel
Q9994 0010 3 In-line cartridge containing digestive enzyme(s) for enteral feeding, each Enzyme cartridge enteral nut
Q9995 0010 3 Injection, emicizumab-kxwh, 0.5 mg Inj., emicizumab-kxwh 0.5 mg