Q2043 HCPCS code: Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion

Q2043 is the HCPCS Level II code for sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion. In 2024 Medicare paid an average of $42,521.00 per service for Q2043 across 1,616 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 outpatient hospital claims. Medicare volume fell 17% from 2022 to 2024 (1,948 to 1,616 services). In 2024, about 444 clinicians billed Medicare for Q2043 for 579 beneficiaries; California, Tennessee, Texas accounted for 25% of services.

Code details

Who bills Q2043 (2024)

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

Medicare utilization for Q2043, 2022–2024

States with the most Q2043 services (2024)

NCCI unit limits (MUE)

Medicare policy articles for this code

• A55719: Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer – Clarification (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))

Covered diagnoses (23 ICD-10-CM codes)

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

Showing 10 of 23. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for Q2043

• 2011-07-01: Q2043 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 Q2043?

Q2043 is the HCPCS Level II code for sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion. Short descriptor: "Sipuleucel-t auto cd54+".

How much does Medicare pay for Q2043?

In 2024, the average Medicare payment was $42,521.00 per service (average allowed $53,367.95).

Does Medicare cover Q2043?

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

Which diagnoses support coverage for Q2043?

Medicare policy articles that cite Q2043 list 23 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C61 (Malignant neoplasm of prostate), C77.1 (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes), C77.2 (Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of Q2043 can be billed per day?

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

Related Q20 codes

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• 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

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Next steps

• Run a reimbursement report for a device billed under Q2043
• Watch Q2043 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for Q2043

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.

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