HCPCS Q9991 & HCPCS Q9992 | Descriptions & Billing Guidelines

HCPCS code Q9991 can be reported for 100 mg or less of extended-release buprenorphine (Sublocade™) and HCPCS code Q9991 if the dose exceeds 100 mg. 

1. What Is A Opioid Use Disorder?

Opioid use disorder refers to a pattern of opioid use that leads to clinically significant impairment or distress characterized by a patient’s;

• craving for opioids;
•  extended use of opioids;
•  an increase in or inability to reduce the amount necessary to relieve pain;
•  increased tolerance to opioids;

Opioid use can also interfere with the patient’s ability to function occupationally and socially and engage in physically hazardous situations.

The drug may also be prescribed for patients going through withdrawal or taking other substances to avoid withdrawal symptoms. The drug is to be used along with counseling and psychosocial support.

2. How To Use Buprenorphine

The recommended initial dose of buprenorphine is 300 mg in each of the first two months, followed by maintenance doses of 100 mg each month.

The maintenance dose may be increased to 300 mg monthly if the benefits outweigh the risks. In addition, the dose may be titrated or incrementally adjusted for patients previously receiving transmucosal buprenorphine–containing drugs.

Buprenorphine is supplied as 100 mg/0.5 mL and 300 mg/1.5 mL in a prefilled syringe with a 19 gauge, 5/8–inch needle.

3. What Is HCPCS Code Q9991?

One unit of HCPC code Q9991 represents 100 mg or less of extended-release buprenorphine (Sublocade™) administered as a monthly subcutaneous injection in the abdomen to treat moderate to severe opioid use disorder.

3.1 Description

Q9991 is officially described in the HCPC book as: “Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg.”

3.2 Usage

Report HCPCS code Q9991 for each unit of 100 mg or less of extended-release buprenorphine administered by subcutaneous injection in the abdomen.

3.3 Billing Guidelines

For doses of Sublocade™ greater than 100 mg, see below for HCPCS code Q9992.

Buprenorphine may be combined with naloxone for oral use; see;

• J0572 to report the supply of this combination with less than or equal to 3 mg buprenorphine,
•  J0573 to report greater than 3 mg but less than or equal to 6 mg buprenorphine,
•  J0574 to report greater than 6 mg but less than or equal to 10 mg buprenorphine, and
•  J0575 to report greater than 10 mg buprenorphine.

4. What Is HCPCS Code Q9992?

One unit of Q9992 represents greater than 100 mg of extended-release buprenorphine (Sublocade™) administered as a monthly subcutaneous injection in the abdomen to treat moderate to severe opioid use disorder.

4.1 Description

The HCPCS book describes Q9992 as follows: “Injection, buprenorphine extended-release (sublocade), greater than 100 mg.”

4.2 Usage

Report HCPCS code Q9992 for each unit of extended-release buprenorphine greater than 100 mg administered by subcutaneous injection in the abdomen.

4.3 Billing Guidelines

Q9992 may be billed for doses of Sublocade™ greater than 100 mg; for amounts equal to or less than 100 mg, see Q9991.

5. Resources

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4083CP.pdf

https://www.medicaid.gov/medicaid/data-and-systems/downloads/macbis/sud_reference_codes.xlsx

https://markets.ft.com/data/announce/detail?dockey=1323-13450309-0TD7AIHVF8B3COPT7GOMBGQL25

https://www.rapiddetox.com/opioid/what-is-opioid-use-disorder/