HCPCS Code Section: HCPCS Q Codes

Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg Short Description: Injection, udenyca 0.5 mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 Effective …

Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram Short Description: Nivestym Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, 2018 Effective Date: …

Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg Short Description: Injection, ixifi, 10 mg Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg Short Description: Injection, fulphila Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: October 1, 2018 Effective Date: October …

Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg Short Description: Inj mvasi 10 mg Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units Short Description: Inj retacrit non-esrd use Coverage Code: Special coverage instructions apply Action Code: Change in long description of …

Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose Short Description: Non-heu tc-99m add-on/dose Coverage Code: Special coverage instructions apply Action Code: No maintenance for …

Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg Short Description: Visualization adjunct Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: …

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml Short Description: Locm 300-399mg/ml iodine,1ml Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date …

Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml Short Description: Locm 200-299mg/ml iodine,1ml Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date …