Question 1

What is HCPCS code Q0516?

Accepted Answer

HCPCS code Q0516 is "Supply fee hiv prep oral 30". Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days

Question 2

What category is Q0516 in?

Accepted Answer

Q0516 belongs to HCPCS Category Q (Temporary Codes).

Question 3

When should I use HCPCS code Q0516?

Accepted Answer

Use Q0516 when billing for supply fee hiv prep oral 30. 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 Q0516 covered by Medicare?

Accepted Answer

Coverage for Q0516 (Supply fee hiv prep oral 30) 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 Q0516?

Accepted Answer

Documentation for Q0516 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).