Question 1

What is HCPCS code Q2043?

Accepted Answer

HCPCS code Q2043 is "Sipuleucel-t auto cd54+". Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion

Question 2

What category is Q2043 in?

Accepted Answer

Q2043 belongs to HCPCS Category Q (Temporary Codes).

Question 3

When should I use HCPCS code Q2043?

Accepted Answer

Use Q2043 when billing for sipuleucel-t auto cd54+. 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

What ICD-10 codes are commonly used with Q2043?

Accepted Answer

Common ICD-10 diagnosis codes used with Q2043 include: C61 (Malignant neoplasm of prostate), C77.1 (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes), C77.2 (Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes), C77.4 (Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is Q2043 covered by Medicare?

Accepted Answer

Coverage for Q2043 (Sipuleucel-t auto cd54+) 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 6

What documentation is required for Q2043?

Accepted Answer

Documentation for Q2043 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).