Q4081 HCPCS code: Injection, epoetin alfa, 100 units (for esrd on dialysis)
Q4081 is the HCPCS Level II code for injection, epoetin alfa, 100 units (for esrd on dialysis). 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 400 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 57 |
| BETOS category | O1E — Other drugs |
| Added | 2007-01-01 |
| Last action effective | 2007-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Clinical: Data |
| practitioner claims | 100 | Clinical: Data |
Medicare policy articles for this code
- A56462: Billing and Coding: Erythropoiesis Stimulating Agents (ESA) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56795: Billing and Coding: Erythropoiesis Stimulating Agents (ESAs) (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A60381: Billing and Coding: Erythropoiesis Stimulating Agents (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,489 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 | 4 |
| B97.35 | Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere | 4 |
| D46.0 | Refractory anemia without ring sideroblasts, so stated | 4 |
| D46.1 | Refractory anemia with ring sideroblasts | 4 |
| D46.20 | Refractory anemia with excess of blasts, unspecified | 4 |
| D46.21 | Refractory anemia with excess of blasts 1 | 4 |
| D46.A | Refractory cytopenia with multilineage dysplasia | 4 |
| D46.B | Refractory cytopenia with multilineage dysplasia and ring sideroblasts | 4 |
| D46.C | Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality | 4 |
| D47.1 | Chronic myeloproliferative disease | 4 |
Showing 10 of 1,489. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q4081
- 2007-01-01: Q4081 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 Q4081?
Q4081 is the HCPCS Level II code for injection, epoetin alfa, 100 units (for esrd on dialysis). Short descriptor: "Epoetin alfa, 100 units esrd".
Does Medicare cover Q4081?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q4081?
Medicare policy articles that cite Q4081 list 1,489 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include B20 (Human immunodeficiency virus [HIV] disease), B97.35 (Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere), D46.0 (Refractory anemia without ring sideroblasts, so stated). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q4081 can be billed per day?
400 on outpatient hospital claims; 100 on practitioner claims (NCCI medically unlikely edits).
Related Q40 codes
- Q4001 — Casting supplies, body cast adult, with or without head, plaster ($62.36–$62.36)
- Q4002 — Cast supplies, body cast adult, with or without head, fiberglass ($235.64–$235.64)
- Q4003 — Cast supplies, shoulder cast, adult (11 years +), plaster ($44.78–$44.78)
- Q4004 — Cast supplies, shoulder cast, adult (11 years +), fiberglass ($155.03–$155.03)
- Q4005 — Cast supplies, long arm cast, adult (11 years +), plaster ($16.51–$16.51)
- Q4006 — Cast supplies, long arm cast, adult (11 years +), fiberglass ($37.20–$37.20)
- Q4007 — Cast supplies, long arm cast, pediatric (0-10 years), plaster ($8.25–$8.25)
- Q4008 — Cast supplies, long arm cast, pediatric (0-10 years), fiberglass ($18.59–$18.59)
- Q4009 — Cast supplies, short arm cast, adult (11 years +), plaster ($11.03–$11.03)
- Q4010 — Cast supplies, short arm cast, adult (11 years +), fiberglass ($24.80–$24.80)
- Q4011 — Cast supplies, short arm cast, pediatric (0-10 years), plaster ($5.50–$5.50)
- Q4012 — Cast supplies, short arm cast, pediatric (0-10 years), fiberglass ($12.43–$12.43)
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 Q4081
- Watch Q4081 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q4081
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.