HCPCS Q0249

Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg

HCPCS Code: Q0249: The Healthcare Common Procedure Coding System (HCPCS) is a set of unique alphanumeric codes used to report medical procedures and services to healthcare programs like Medicare and Medicaid. HCPCS codes are used in conjunction with NDC codes for billing and medical documentation puporses. For instance, HCPCS Q0249 identifies the type of service or supply used while any of the 3 NDC codes below could be used to specify the exact drug used.
Short Description: Tocilizumab for covid-19
Long Description: Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
Pricing Indicator: Vaccinations
Multiple Pricing Indicator: Not applicable as HCPCS priced under one methodology
Coverage Description: Carrier judgment
BETOS Type of Service: Immunizations/Vaccinations
Medicare Payment Limit: $7.57
Medicare Co-Insurance Percentage: 0.000%
Medicare Pricing Notes: See COVID-19 vaccine pricing webpage for payment effective dates
HCPCS Classification: List of HCPCS codes for: Temporary Codes (Q-codes)

The NDC codes below allow precise billing based on the specific manufacturer and medication used:

NDC	Proprietary Name	Non-Proprietary Name	Dosage Form	Route Name	Company Name	Status
50242-135	Actemra	Tocilizumab	Injection, Solution, Concentrate	Intravenous	Genentech, Inc.	ACTIVE
50242-136	Actemra	Tocilizumab	Injection, Solution, Concentrate	Intravenous	Genentech, Inc.	ACTIVE
50242-137	Actemra	Tocilizumab	Injection, Solution, Concentrate	Intravenous	Genentech, Inc.	ACTIVE