Q2042
Q2042 – Tisagenlecleucel, up to 600 million car-positive viable t cells, includi · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 2 NDCs crosswalked per up to 600 million CAR-positive viable T cells $611,693.171/unit ASP+6%
📋 Q2042 summary
Q2042 is a HCPCS Level II Q-code used to bill Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis a..., billed per up to 600 million CAR-positive viable T cells. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with Q2042: Kymriah
Code Q2042
Billing unit up to 600 million CAR-positive viable T cells Payment limit $611,693.171/unit NDC-Crosswalk 2
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeQ2042
DescriptorTisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Billing unitup to 600 million CAR-positive viable T cells
Payment limit / unit$611,693.171
Est. ASP / unit$577,069.029 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-09-20
💊 About Tisagenlecleucel Injection DRUG GUIDE
Kymriah is used to treat three types of blood cancer that have come back or stopped responding to treatment.
It is approved for patients up to 25 years old with B-cell precursor acute lymphoblastic leukemia (ALL) that has relapsed at least twice or has not responded to treatment.
It is also approved for adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) — including high-grade B-cell lymphoma and DLBCL arising from follicular lymphoma — after two or more prior therapies.
Kymriah is not approved for primary central nervous system lymphoma.Kymriah is also approved for adults with relapsed or refractory follicular lymphoma (FL) after two or more prior therapies.
Clinical overview from our editorial drug guide for Tisagenlecleucel Injection. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$611,693.171
Est. ASP / unit
$577,069.029 est.
Est. after 2% sequester
$599,459.308
HCPCS dosage
up to 600 million CAR-positive viable T cells
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionTisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeN — No maintenance this year
Effective date2019-01-01
Date added2019-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of Q2042 = 600 million. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under Q2042 WITH EST. MEDICARE PAY
2 NDCs map to Q2042. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($611,693.171/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00078-0846-19 | KYMRIAH tisagenlecleucel 2000000 1/1 INJECTION, SUSPENSION | Novartis | 1 INJECTION, SUSPENSION in 1 BAG (0078-084... | 2000000 1/1 | 1 | $611,693.17 | — | ● Active | CMS ASP |
| 00078-0958-19 | KYMRIAH tisagenlecleucel 60000000 1/1 INJECTION, SUSPENSION | Novartis | 1 INJECTION, SUSPENSION in 1 BAG (0078-095... | 60000000 1/1 | 1 | $611,693.17 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
🗺️ Where Q2042 is utilized
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The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-09-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
2 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
No reportable utilization
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ Q2042 billing FAQ
What is HCPCS code Q2042?
Q2042 is a HCPCS Level II Q-code used to bill Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q2042?
One unit of Q2042 represents up to 600 million CAR-positive viable T cells. Report the number of units equal to the dose administered divided by up to 600 million CAR-positive viable T cells.
How many units of Q2042 should I bill?
Divide the dose administered by the code's unit size (up to 600 million CAR-positive viable T cells) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for Q2042?
The Medicare Part B payment limit is $611,693.171 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $599,459.308 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q2042?
2 NDCs currently map to Q2042 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean Q2042 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.