Q2028 HCPCS code: Injection, sculptra, 0.5 mg
Q2028 is the HCPCS Level II code for injection, sculptra, 0.5 mg. In 2024 Medicare paid an average of $0.67 per service for Q2028 across 758,442 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 1470 per day on outpatient hospital claims. Medicare volume rose 96% from 2022 to 2024 (386,458 to 758,442 services). In 2024, about 31 clinicians billed Medicare for Q2028 for 191 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2014-01-01 |
| Last action effective | 2019-01-01 |
Who bills Q2028 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 31 |
| Medicare beneficiaries | 191 |
| States with claims | 3 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q2028, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 386,458 | 142 | $1.22 | $0.97 |
| 2023 | 557,030 | 170 | $1.10 | $0.87 |
| 2024 | 758,442 | 191 | $0.85 | $0.67 |
States with the most Q2028 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 622,456 | $0.73 |
| New York | 41,160 | $0.39 |
| Massachusetts | 34,545 | $0.45 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1470 | Clinical: Data |
| practitioner claims | 1470 | Clinical: Data |
Medicare policy articles for this code
- A58774: Billing and Coding: Cosmetic and Reconstructive Surgery (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A59299: Billing and Coding: Cosmetic and Reconstructive Surgery (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
Covered diagnoses (226 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | 2 |
| C30.0 | Malignant neoplasm of nasal cavity | 2 |
| C41.0 | Malignant neoplasm of bones of skull and face | 2 |
| C43.31 | Malignant melanoma of nose | 2 |
| C43.39 | Malignant melanoma of other parts of face | 2 |
| C44.300 | Unspecified malignant neoplasm of skin of unspecified part of face | 2 |
| C44.301 | Unspecified malignant neoplasm of skin of nose | 2 |
| C44.309 | Unspecified malignant neoplasm of skin of other parts of face | 2 |
| C44.310 | Basal cell carcinoma of skin of unspecified parts of face | 2 |
| C44.311 | Basal cell carcinoma of skin of nose | 2 |
Showing 10 of 226. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q2028
- 2014-01-01: Q2028 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 Q2028?
Q2028 is the HCPCS Level II code for injection, sculptra, 0.5 mg. Short descriptor: "Inj, sculptra, 0.5mg".
How much does Medicare pay for Q2028?
In 2024, the average Medicare payment was $0.67 per service (average allowed $0.85).
Does Medicare cover Q2028?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q2028?
Medicare policy articles that cite Q2028 list 226 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include B20 (Human immunodeficiency virus [HIV] disease), C30.0 (Malignant neoplasm of nasal cavity), C41.0 (Malignant neoplasm of bones of skull and face). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q2028 can be billed per day?
1470 on outpatient hospital claims; 1470 on practitioner claims (NCCI medically unlikely edits).
Related Q20 codes
- Q2004 — Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
- Q2009 — Injection, fosphenytoin, 50 mg phenytoin equivalent
- Q2017 — Injection, teniposide, 50 mg
- Q2026 — Injection, radiesse, 0.1 ml
- Q2034 — Influenza virus vaccine, split virus, for intramuscular use (agriflu)
- Q2035 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
- Q2036 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
- Q2037 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
- Q2038 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
- Q2039 — Influenza virus vaccine, not otherwise specified
- Q2040 — Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
- Q2041 — Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
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 Q2028
- Watch Q2028 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q2028
Sources: CMS HCPCS Level II release October 2026; 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.