HCPCS Code Section: HCPCS Q Codes

Compounded drug, not otherwise classified Short Description: Compounded drug noc Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2015 Effective …

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg Short Description: Inj., triamcinolone ext rel Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date …

Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron Short Description: Inj ferric pyrophosphate cit Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July …

Injection, buprenorphine extended-release (sublocade), greater than 100 mg Short Description: Buprenorphine xr over 100 mg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July …

Injection, factor viii fc fusion protein (recombinant), per iu Short Description: Factor viii fc fusion recomb Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code …

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: …