Q0513 HCPCS code: Pharmacy dispensing fee for inhalation drug(s); per 30 days
Q0513 is the HCPCS Level II code for pharmacy dispensing fee for inhalation drug(s); per 30 days. In 2024 Medicare paid an average of $23.94 per service for Q0513 across 1,197,146 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 30% from 2022 to 2024 (1,698,691 to 1,197,146 services). In 2024, 35,933 suppliers billed Medicare for Q0513 (purchases), serving 339,626 beneficiaries; California, Texas, Florida accounted for 20% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | O1E — Other drugs |
| Added | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills Q0513 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 35,933 |
| Referring clinicians | 121,630 |
| Medicare beneficiaries | 339,626 |
| States with claims | 53 |
| Share of services in top 3 states (California, Texas, Florida) | 20% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 39,640 | 418,910 |
| 2023 | 38,453 | 376,793 |
| 2024 | 35,933 | 339,626 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q0513, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,698,691 | 418,910 | $33.00 | $24.19 |
| 2023 | 1,510,126 | 376,793 | $33.00 | $24.21 |
| 2024 | 1,197,146 | 339,626 | $33.00 | $23.94 |
States with the most Q0513 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 93,515 | $23.61 |
| Texas | 72,515 | $24.31 |
| Florida | 67,935 | $24.19 |
| New York | 60,493 | $23.83 |
| Illinois | 55,758 | $23.87 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (215 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A15.0 | Tuberculosis of lung | 1 |
| A22.1 | Pulmonary anthrax | 1 |
| A37.01 | Whooping cough due to Bordetella pertussis with pneumonia | 1 |
| A37.11 | Whooping cough due to Bordetella parapertussis with pneumonia | 1 |
| A37.81 | Whooping cough due to other Bordetella species with pneumonia | 1 |
| A37.91 | Whooping cough, unspecified species with pneumonia | 1 |
| A48.1 | Legionnaires' disease | 1 |
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| B25.0 | Cytomegaloviral pneumonitis | 1 |
| B44.0 | Invasive pulmonary aspergillosis | 1 |
Showing 10 of 215. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q0513
- 2006-01-01: Q0513 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 Q0513?
Q0513 is the HCPCS Level II code for pharmacy dispensing fee for inhalation drug(s); per 30 days. Short descriptor: "Disp fee inhal drugs/30 days".
How much does Medicare pay for Q0513?
In 2024, the average Medicare payment was $23.94 per service (average allowed $33.00).
Does Medicare cover Q0513?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q0513?
Medicare policy articles that cite Q0513 list 215 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A15.0 (Tuberculosis of lung), A22.1 (Pulmonary anthrax), A37.01 (Whooping cough due to Bordetella pertussis with pneumonia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q0513 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
- Q0511 — Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period
- Q0512 — Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period
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 Q0513
- Watch Q0513 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q0513
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.