Q0224 HCPCS code: 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
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. In 2024 Medicare paid an average of $199.01 per service for Q0224 across 23,603 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. In 2024, about 196 clinicians billed Medicare for Q0224 for 425 beneficiaries; Texas, Pennsylvania, California accounted for 98% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 54 |
| BETOS category | O1G — Immunizations/vaccinations |
| Added | 2024-03-22 |
| Last action effective | 2024-03-22 |
Who bills Q0224 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 196 |
| Medicare beneficiaries | 425 |
| States with claims | 10 |
| Share of services in top 3 states (Texas, Pennsylvania, California) | 98% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q0224, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 23,603 | 425 | $199.01 | $199.01 |
States with the most Q0224 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 22,563 | $14.95 |
| Pennsylvania | 200 | $2,336.78 |
| California | 171 | $4,356.37 |
| Illinois | 148 | $1,968.59 |
| Florida | 109 | $4,939.11 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
What changed for Q0224
- 2024-03-22: Q0224 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q0224?
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. Short descriptor: "Inj, pemivibart, 4500 mg".
How much does Medicare pay for Q0224?
In 2024, the average Medicare payment was $199.01 per service (average allowed $199.01).
Does Medicare cover Q0224?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of Q0224 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related Q02 codes
- Q0220 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg
- Q0221 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
- Q0222 — Injection, bebtelovimab, 175 mg
- Q0235 — Injection, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, not otherwise classified, 1 mg
- Q0237 — Injection, tocilizumab-anoh, for hospitalized adult patients 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
- Q0239 — Injection, bamlanivimab-xxxx, 700 mg
- Q0240 — Injection, casirivimab and imdevimab, 600 mg
- Q0243 — Injection, casirivimab and imdevimab, 2400 mg
- Q0244 — Injection, casirivimab and imdevimab, 1200 mg
- Q0245 — Injection, bamlanivimab and etesevimab, 2100 mg
- Q0247 — Injection, sotrovimab, 500 mg
- 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q0224
- Watch Q0224 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q0224
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.