HCPCS Code Details - Q2043

HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q2043
Description

Long description:
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+

HCPCS Modifier1
HCPCS Pricing indicator 53 - Statute
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Jul 01, 2011 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code P1G - Major procedure - Other
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jul 01, 2011
Date added Added Jul 01, 2011
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - Q2043

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
January 1, 2021 - March 31, 2021 Per infusion (minimum 50 million cells) 49649.408 - - - - - -
October 1, 2020 - December 31, 2020 Per infusion (minimum 50 million cells) 49671.772 - - - - - -
July 1, 2020 - September 30, 2020 Per infusion (minimum 50 million cells) 47617.865 - - - - - -
April 1, 2020 - June 30, 2020 Per infusion (minimum 50 million cells) 47986.306 - - - - - -
January 1, 2020 - March 31, 2020 Per infusion (minimum 50 million cells) 45942.628 - - - - - -

See also

  • HCPCS Q2042 · Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

  • HCPCS Q2049 · Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”