Q0511 HCPCS code: Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period

Q0511 is the HCPCS Level II code for pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period. In 2024 Medicare paid an average of $17.88 per service for Q0511 across 862,036 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume fell 7% from 2022 to 2024 (928,341 to 862,036 services). In 2024, 22,227 suppliers billed Medicare for Q0511 (purchases), serving 120,226 beneficiaries; California, New York, Texas accounted for 26% of services.

Code details

Who bills Q0511 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for Q0511, 2022–2024

States with the most Q0511 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A52474: Immunosuppressive Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
• A52479: Oral Anticancer Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
• A52480: Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance

Covered diagnoses (1,551 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 1,551. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for Q0511

• 2006-01-01: Q0511 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 Q0511?

Q0511 is the HCPCS Level II code for pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period. Short descriptor: "Sup fee antiem,antica,immuno".

How much does Medicare pay for Q0511?

In 2024, the average Medicare payment was $17.88 per service (average allowed $24.00).

Does Medicare cover Q0511?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for Q0511?

Medicare policy articles that cite Q0511 list 1,551 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.3 (Malignant neoplasm of upper lip, inner aspect). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of Q0511 can be billed per day?

1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).

Related Q05 codes

• Q0500 — Filters for use with electric or electric/pneumatic ventricular assist device, replacement only ($36.71–$40.36)
• Q0501 — Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only ($613.75–$675.13)
• Q0502 — Mobility cart for pneumatic ventricular assist device, replacement only ($781.39–$859.54)
• Q0503 — Battery for pneumatic ventricular assist device, replacement only, each ($1,562.84–$1,719.11)
• Q0504 — Power adapter for pneumatic ventricular assist device, replacement only, vehicle type ($824.68–$907.15)
• Q0506 — Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only ($1,026.54–$1,129.20)
• Q0507 — Miscellaneous supply or accessory for use with an external ventricular assist device
• Q0508 — Miscellaneous supply or accessory for use with an implanted ventricular assist device
• Q0509 — Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a
• Q0510 — Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant
• Q0512 — Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period
• Q0513 — Pharmacy dispensing fee for inhalation drug(s); per 30 days

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Next steps

• Run a reimbursement report for a device billed under Q0511
• Watch Q0511 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for Q0511

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.

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