Question 1

What is HCPCS code Q0224?

Accepted Answer

HCPCS code Q0224 is "Inj, pemivibart, 4500 mg". Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg

Question 2

What category is Q0224 in?

Accepted Answer

Q0224 belongs to HCPCS Category Q (Temporary Codes).

Question 3

When should I use HCPCS code Q0224?

Accepted Answer

Use Q0224 when billing for inj, pemivibart, 4500 mg. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is Q0224 covered by Medicare?

Accepted Answer

Coverage for Q0224 (Inj, pemivibart, 4500 mg) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for Q0224?

Accepted Answer

Documentation for Q0224 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).