HCPCS Code Section: HCPCS Q Codes

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: …

Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg Short Description: Genvisc, inj, 1mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January …

Injection, alemtuzumab, 1 mg Short Description: Injection, alemtuzumab Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, 2015 Effective Date: January …