No. Q0224 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code.

What is the Medicare payment limit for Q0224?

$7,615.20 per 4500 mg, effective October 1, 2026 through December 31, 2026, from CMS's Part B drug payment limit file. Multiply by the units billed for the allowed amount before deductible and coinsurance. It is not a coverage decision.

What is one billing unit of Q0224?

One unit of Q0224 is 4500 mg, as stated in the code's descriptor. Units to report = dose given ÷ 4500 mg.

Q0224 HCPCS Code: Pemivibart — Billing Units & NDCs

In short

Q0224 is the HCPCS Level II code for 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. One billing unit is 4500 mg. The Medicare Part B payment limit is $7,615.20 per unit (October 1, 2026 through December 31, 2026).

Code

CMS HCPCS file

HCPCS codeQ0224

Billing unit4500 mg

Descriptor: 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
Short descriptor: Inj, pemivibart, 4500 mg
Code set: HCPCS Level II, maintained by CMS
Effective: Mar 22, 2024

The billing unit is read from the descriptor. Confirm it against the CMS file before billing.

Medicare Part B payment limit

CMS ASP file

Payment limit per unit$7,615.20

Per4500 mg

Coinsurance0%

Effective October 1, 2026 through December 31, 2026. Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data. CMS note: See COVID-19 vaccine pricing webpage for payment effective dates. A payment limit is not a coverage decision; the Medicare contractor decides coverage. CMS ASP pricing files

Units and claim line

Units = dose given ÷ 4500 mg. For example, 450000 mg is 100 units. Enter the dose to get the units and the NDC line for the CMS-1500 and the 837P.

Dose given (mg)

HCPCS units (1 unit = 4,500 mg)

Modifier

NDC (11-digit)

NDC unit qualifier

NDC quantity

Enter the dose given to build the claim line.

Find the NDC

Med-Code hasn’t mapped Q0224 to specific products yet. Search the FDA NDC Directory for the drug named in the descriptor, and check the route and strength match the code.

Search NDCs for pemivibart

Q0224: common questions

Is Q0224 a CPT code?: No. Q0224 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code. CPT codes for drug administration.
What is the Medicare payment limit for Q0224?: $7,615.20 per 4500 mg, effective October 1, 2026 through December 31, 2026, from CMS's Part B drug payment limit file. Multiply by the units billed for the allowed amount before deductible and coinsurance. It is not a coverage decision.
What is one billing unit of Q0224?: One unit of Q0224 is 4500 mg, as stated in the code's descriptor. Units to report = dose given ÷ 4500 mg. J-code billing units.