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Q2043

Q2043 – Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated wit · NDC Crosswalk & Billing Units

HCPCS Level II Q-code · Medicare Part B drug billing
Q-code ● 1 NDC crosswalked per Per infusion (minimum 50 million cells) $55,932.427/unit ASP+6%

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 Q2043 summary

Q2043 is a HCPCS Level II Q-code used to bill Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, incl..., billed per Per infusion (minimum 50 million 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 Q2043: Provenge

Code Q2043 Billing unit Per infusion (minimum 50 million cells) Payment limit $55,932.427/unit NDC-Crosswalk 1 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 codeQ2043
DescriptorSipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
Billing unitPer infusion (minimum 50 million cells)
Payment limit / unit$55,932.427
Est. ASP / unit$52,766.441 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20

💊 About Sipuleucel-T Injection DRUG GUIDE

Provenge (sipuleucel-T) is used to treat metastatic castrate-resistant prostate cancer — prostate cancer that has spread to other parts of the body and is no longer responding to hormone therapy.

It is intended for men whose cancer is causing no symptoms or only mild symptoms.

Read the full Sipuleucel-T Injection drug guide →
Clinical overview from our editorial drug guide for Sipuleucel-T 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
$55,932.427
Est. ASP / unit
$52,766.441 est.
Est. after 2% sequester
$54,813.778
HCPCS dosage
Per infusion (minimum 50 million 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 descriptionSipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
CoverageD — Special coverage instructions apply
Pricing indicator53
Type of service1 — Medical care
BETOS-2P1G
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2011-07-01
Date added2011-07-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of Q2043 = 50 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 Q2043 WITH EST. MEDICARE PAY

1 NDC map to Q2043. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($55,932.427/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
30237-8900-06 PROVENGE sipuleucel-T 50000000 1/1 INJECTION Dendreon 1 BAG in 1 CARTON (30237-8900-6) / 1 INJE... 50000000 1/1 1 $55,932.43 — ● 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.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Period
Total Part B spend
$15.72M
Claims
290
Beneficiaries
135
Spend / beneficiary
$116,454.04
Spend / claim
$54,211.36
Trend by period
Where Q2043 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #139 of 824
#134 ALYMSYS Q5126 $16.72M #135 IDELVION J7202 $16.67M #136 NIKTIMVO J9038 $16.36M #137 RYSTIGGO J9333 $16.15M #138 ZIRABEV Q5118 $15.94M #139 PROVENGE Q2043 $15.72M #140 ALPROLIX J7201 $15.58M #141 BRIUMVI J2329 $15.51M #142 ZILRETTA J3304 $15.4M #143 FABRAZYME J0180 $15.28M #144 MONOVISC J7327 $15.25M
Total claims — #506 of 824
#501 FLUPHENAZINE DECANOA... J2680 307 #502 MYCOPHENOLATE MOFETI... J7528 299 #503 JELMYTO J9281 296 #504 OCREVUS ZUNOVO J2351 292 #505 FOLOTYN* J9307 291 #506 PROVENGE Q2043 290 #507 ENOXAPARIN SODIUM* J1650 288 #508 REZZAYO J0349 281 #509 CYTAL, PER SQUARE CE... Q4166 272 #510 ACESSO TL, PER SQ CM... Q4300 265 #511 LEVOLEUCOVORIN CALCI... J0641 264

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $15.72M 135 290 $116,454.04 $54,211.36
2025 (Q1-Q4) $88.07M 602 1,584 $146,296.27 $55,599.97
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.

📈 Medicare Part B claims detail CMS PSPS · 2024

Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$45.85M
Medicare paid
$54.69M
Submitted services
943
Denial rate
3.0%
Allowed / service
$50,106.63
Submitted charges
$74.57M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.

🗺️ Where Q2043 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 75 services across 2 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.

🗃️ 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 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
1 NDC 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
Latest data year 2026
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.

❓ Q2043 billing FAQ

What is HCPCS code Q2043?
Q2043 is a HCPCS Level II Q-code used to bill Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q2043?
One unit of Q2043 represents Per infusion (minimum 50 million cells). Report the number of units equal to the dose administered divided by Per infusion (minimum 50 million cells).
How many units of Q2043 should I bill?
Divide the dose administered by the code's unit size (Per infusion (minimum 50 million 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 Q2043?
The Medicare Part B payment limit is $55,932.427 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $54,813.778 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q2043?
1 NDC currently map to Q2043 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 Q2043 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.