HCPCS Q2043 (Provenge) Fee Schedule

HCPCS Q2043 vs. Other Other Drugs and Service Fees Codes

The HCPCS Q2043 code is part of the Temporary Codes services used for Other Drugs and Service Fees. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS Q2043 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q2043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the Q2043 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.