HCPCS Code Section: HCPCS Q Codes

Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg Short Description: Imported lipodox inj Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: July 1, 2012 …

Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion Short Description: Sipuleucel-t auto cd54+ Coverage Code: Special coverage …

Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose Short Description: Tisagenlecleucel car-pos t Coverage Code: Carrier judgment Action Code: …

Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose Short Description: Axicabtagene ciloleucel car+ Coverage Code: …

Cast supplies, long arm cast, adult (11 years +), plaster Short Description: Cast sup long arm adult plst Coverage Code: Carrier judgment Action Code: No maintenance for this code …

Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion Short Description: Tisagenlecleucel car-pos t Coverage Code: Carrier judgment Action Code: No …

Cast supplies, shoulder cast, adult (11 years +), fiberglass Short Description: Cast sup shoulder cast fbrgl Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: …

Influenza virus vaccine, not otherwise specified Short Description: Influenza virus vaccine, nos Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

Cast supplies, shoulder cast, adult (11 years +), plaster Short Description: Cast sup shoulder cast plstr Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: …

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) Coverage Code: Special coverage instructions apply Action Code: No maintenance …