Q Codes

Q Codes

Q0035

Cardiokymography

Q0081

Infusion therapy, using other than chemotherapeutic drugs, per visit

Q0083

Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit

Q0084

Chemotherapy administration by infusion technique only, per visit

Q0085

Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit

Q0090

Levonorgestrel-releasing intrauterine contraceptive system, (skyla), 13.5 mg

Q0091

Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

Q0092

Set-up portable x-ray equipment

Q0111

Wet mounts, including preparations of vaginal, cervical or skin specimens

Q0112

All potassium hydroxide (koh) preparations

Q0113

Pinworm examinations

Q0114

Fern test

Q0115

Post-coital direct, qualitative examinations of vaginal or cervical mucous

Q0138

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)

Q0139

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)

Q0144

Azithromycin dihydrate, oral, capsules/powder, 1 gram

Q0161

Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0162

Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0163

Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen

Q0164

Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0165

Prochlorperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0166

Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen

Q0167

Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0168

Dronabinol, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0169

Promethazine hydrochloride, 12.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0170

Promethazine hydrochloride, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0171

Chlorpromazine hydrochloride, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0172

Chlorpromazine hydrochloride, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0173

Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0174

Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0175

Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0176

Perphenazine, 8mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0177

Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0178

Hydroxyzine pamoate, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0180

Dolasetron mesylate, 100 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen

Q0181

Unspecified oral dosage form, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for a iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Q0478

Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type

Q0479

Power module for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0480

Driver for use with pneumatic ventricular assist device, replacement only

Q0481

Microprocessor control unit for use with electric ventricular assist device, replacement only

Q0482

Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only

Q0483

Monitor/display module for use with electric ventricular assist device, replacement only

Q0484

Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0485

Monitor control cable for use with electric ventricular assist device, replacement only

Q0486

Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only

Q0487

Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only

Q0488

Power pack base for use with electric ventricular assist device, replacement only

Q0489

Power pack base for use with electric/pneumatic ventricular assist device, replacement only

Q0490

Emergency power source for use with electric ventricular assist device, replacement only

Q0491

Emergency power source for use with electric/pneumatic ventricular assist device, replacement only

Q0492

Emergency power supply cable for use with electric ventricular assist device, replacement only

Q0493

Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only

Q0494

Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0495

Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0496

Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0497

Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0498

Holster for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0499

Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only

Q0500

Filters for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0501

Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0502

Mobility cart for pneumatic ventricular assist device, replacement only

Q0503

Battery for pneumatic ventricular assist device, replacement only, each

Q0504

Power adapter for pneumatic ventricular assist device, replacement only, vehicle type

Q0505

Miscellaneous supply or accessory for use with ventricular assist device

Q0506

Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only

Q0507

Miscellaneous supply or accessory for use with an external ventricular assist device

Q0508

Miscellaneous supply or accessory for use with an implanted ventricular assist device

Q0509

Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a

Q0510

Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant

Q0511

Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period

Q0512

Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period

Q0513

Pharmacy dispensing fee for inhalation drug(s); per 30 days

Q0514

Pharmacy dispensing fee for inhalation drug(s); per 90 days

Q0515

Injection, sermorelin acetate, 1 microgram

Q1004

New technology intraocular lens category 4 as defined in federal register notice

Q1005

New technology intraocular lens category 5 as defined in federal register notice

Q2004

Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml

Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent

Q2017

Injection, teniposide, 50 mg

Q2026

Injection, radiesse, 0.1 ml

Q2027

Injection, sculptra, 0.1 ml

Q2028

Injection, sculptra, 0.5 mg

Q2033

Influenza vaccine, recombinant hemagglutinin antigens, for intramuscular use (flublok)

Q2034

Influenza virus vaccine, split virus, for intramuscular use (agriflu)

Q2035

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)

Q2036

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)

Q2037

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)

Q2038

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)

Q2039

Influenza virus vaccine, not otherwise specified

Q2043

Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion

Q2049

Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg

Q2050

Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg

Q2051

Injection, zoledronic acid, not otherwise specified, 1mg

Q2052

Services, supplies and accessories used in the home under the medicare intravenous immune globulin (ivig) demonstration

Q3001

Radioelements for brachytherapy, any type, each

Q3014

Telehealth originating site facility fee

Q3025

Injection, interferon beta-1a, 11 mcg for intramuscular use

Q3026

Injection, interferon beta-1a, 11 mcg for subcutaneous use

Q3027

Injection, interferon beta-1a, 1 mcg for intramuscular use

Q3028

Injection, interferon beta-1a, 1 mcg for subcutaneous use

Q3031

Collagen skin test

Q4001

Casting supplies, body cast adult, with or without head, plaster

Q4002

Cast supplies, body cast adult, with or without head, fiberglass

Q4003

Cast supplies, shoulder cast, adult (11 years +), plaster

Q4004

Cast supplies, shoulder cast, adult (11 years +), fiberglass

Q4005

Cast supplies, long arm cast, adult (11 years +), plaster

Q4006

Cast supplies, long arm cast, adult (11 years +), fiberglass

Q4007

Cast supplies, long arm cast, pediatric (0-10 years), plaster

Q4008

Cast supplies, long arm cast, pediatric (0-10 years), fiberglass

Q4009

Cast supplies, short arm cast, adult (11 years +), plaster

Q4010

Cast supplies, short arm cast, adult (11 years +), fiberglass

Q4011

Cast supplies, short arm cast, pediatric (0-10 years), plaster

Q4012

Cast supplies, short arm cast, pediatric (0-10 years), fiberglass

Q4013

Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster

Q4014

Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass

Q4015

Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster

Q4016

Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass

Q4017

Cast supplies, long arm splint, adult (11 years +), plaster

Q4018

Cast supplies, long arm splint, adult (11 years +), fiberglass

Q4019

Cast supplies, long arm splint, pediatric (0-10 years), plaster

Q4020

Cast supplies, long arm splint, pediatric (0-10 years), fiberglass

Q4021

Cast supplies, short arm splint, adult (11 years +), plaster

Q4022

Cast supplies, short arm splint, adult (11 years +), fiberglass

Q4023

Cast supplies, short arm splint, pediatric (0-10 years), plaster

Q4024

Cast supplies, short arm splint, pediatric (0-10 years), fiberglass

Q4025

Cast supplies, hip spica (one or both legs), adult (11 years +), plaster

Q4026

Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass

Q4027

Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster

Q4028

Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass

Q4029

Cast supplies, long leg cast, adult (11 years +), plaster

Q4030

Cast supplies, long leg cast, adult (11 years +), fiberglass

Q4031

Cast supplies, long leg cast, pediatric (0-10 years), plaster

Q4032

Cast supplies, long leg cast, pediatric (0-10 years), fiberglass

Q4033

Cast supplies, long leg cylinder cast, adult (11 years +), plaster

Q4034

Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass

Q4035

Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster

Q4036

Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass

Q4037

Cast supplies, short leg cast, adult (11 years +), plaster

Q4038

Cast supplies, short leg cast, adult (11 years +), fiberglass

Q4039

Cast supplies, short leg cast, pediatric (0-10 years), plaster

Q4040

Cast supplies, short leg cast, pediatric (0-10 years), fiberglass

Q4041

Cast supplies, long leg splint, adult (11 years +), plaster

Q4042

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