HCPCS Code Section: HCPCS Q Codes

Injection, iron-based magnetic resonance contrast agent, per ml Short Description: Inj fe-based mr contrast,1ml Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: …

Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units Short Description: Inj retacrit esrd on dialysi Coverage Code: Special coverage instructions apply Action Code: Change in long …

Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml Short Description: Locm >= 400 mg/ml iodine,1ml Coverage Code: Special coverage instructions apply Action Code: No maintenance …

Injection, infliximab-abda, biosimilar, (renflexis), 10 mg Short Description: Injection, renflexis Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: April 1, 2018 Effective …

Injection, sulfur hexafluoride lipid microspheres, per ml Short Description: Inj sulf hexa lipid microsph Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, …

Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg Short Description: Injection, inflectra Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: April 1, 2018 Effective …

Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg Short Description: Inj., zirabev, 10 mg Coverage Code: Carrier judgment Action Code: Add procedure or modifier code Date Added: October 1, 2019 Effective …

Injection, infliximab, biosimilar, 10 mg Short Description: Inj., infliximab biosimilar Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2016 Effective …

Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg Short Description: Inj., kanjinti, 10 mg Coverage Code: Carrier judgment Action Code: Add procedure or modifier code Date Added: October 1, 2019 Effective …

Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg Short Description: Inj., trazimera, 10 mg Coverage Code: Carrier judgment Action Code: Add procedure or modifier code Date Added: October 1, 2019 Effective …