HCPCS Code Section: HCPCS Q Codes

Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg Short Description: Buprenorph xr 100 mg or less Coverage Code: Carrier judgment Action Code: No maintenance for this …

Ustekinumab, for intravenous injection, 1 mg Short Description: Ustekinumab, iv inject,1 mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July 1, 2017 Effective …

Platelets, pheresis, pathogen-reduced, each unit Short Description: Platelets, pathogen reduced Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2017 Effective …

Pathogen(s) test for platelets Short Description: Pathogen test for platelets Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2017 Effective …

Injection, hydroxyprogesterone caproate, (makena), 10 mg Short Description: Makena, 10 mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July 1, 2017 Effective Date: …

Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg Short Description: Inj hydroxyprogst capoat nos Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July 1, …

Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg Short Description: Kyleena, 19.5 mg Coverage Code: Non-covered by Medicare statute Action Code: No maintenance for this code Date Added: July 1, …

Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries Short Description: Florbetaben f18 diagnostic Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date …

Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries Short Description: Flutemetamol f18 diagnostic Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date …

Rolapitant, oral, 1 mg Short Description: Rolapitant, oral, 1mg Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2016 Effective Date: …