Q0521 HCPCS code: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
Q0521 is the HCPCS Level II code for pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription. 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.
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 | 2025-01-01 |
| Last action effective | 2025-01-01 |
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 |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
What changed for Q0521
- 2025-01-01: Q0521 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 Q0521?
Q0521 is the HCPCS Level II code for pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription. Short descriptor: "Supply fee hiv prep fda appr".
Does Medicare cover Q0521?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of Q0521 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims; 1 on practitioner 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
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Next steps
- Run a reimbursement report for a device billed under Q0521
- Watch Q0521 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q0521
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.