HCPCS Code Q2043 | Description & Billing Guidelines
HCPCS Q2043 can be billed for one unit of sipuleucel–T for treating metastatic hormone-refractory prostate cancer.
1. What Is HCPCS Code Q2043?
HCPCS Q2043 covers the supply of sipuleucel–T for treating metastatic, hormone-refractory prostate cancer.
One unit of Q2043 represents a dose of a minimum of 50 million autologous cd54+ cells activated with prostatic acid phosphatase (PAP) and granulocyte-macrophage colony-stimulating factor(GM–CSF), administered via an intravenous infusion through a vein.
Q2043 includes all preparatory procedures, including leukapheresis, the separation of white blood cells from the blood to make the blood useful for transplant purposes.
2. Description
The official description of Q2043 is: “Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion.”
3. Explanation
Sipuleucel–T is autologous cellular immunotherapy given to a patient as an intravenous infusion to manage minimally symptomatic hormone-refractory prostate cancer.
Each dose of sipuleucel–T contains 50 million autologous CD54+ cells activated with PAP GM–CSF in 250 mL of lactated Ringer’s solution.
This is given to the patient by intravenous (IV) infusion for one hour in three complete doses over two weeks.
Under any circumstances, if the patient fails to receive the scheduled dose, he must go through leukapheresis before administering another dose of sipuleucel–T.
4. Billing Guidelines
A brand name for Q2043 is Provenge®.
The preparatory procedures, such as the collection of cells, transportation, storage in the lab, and then infusion of the cells, are all included in HCPCS code Q2043.
You should report code CPT 96365 in conjunction with Q2043 for intravenous infusion of sipuleucel T.
5. References
http://www.cms.gov/transmittals/downloads/R2380CP.pdf
http://www.cms.gov/transmittals/downloads/R2394CP.pdf
http://www.cms.gov/transmittals/downloads/R140NCD.pdf
Buck’s 2022 HCPCS Level II E-Book
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52926&ver=9&
