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See a sample rate comparisonHCPCS Q2043 (Provenge) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Other Drugs and Service Fees |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for Q2043 |
| Medicare Payment Limit | $55272.324  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS Q2043 by major payers:
$48,242.26
$58,275.87
$59,767.50
$58,446.70
Compare published rates across providers.
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HCPCS Q2043
5 of 25 sample ratesHigher to lower in this preview
Kevin Schlessel
Columbus Arthritis Center
$71,370.11Published rateUniversity Healthcare System, L.C., Tulane Lakeside Hospital
Lcmc Health Holdings Inc
$55,512.78Published rateGeorge Hemstreet
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$55,015.23Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$53,426.66Published rateChristopher Raio
Mercy Medical Center
$48,083.99Published rate
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See a sample payer proposalHCPCS 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.
| Code | Complexity | Description |
|---|---|---|
| Q2042-HCPCS | High | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2043-HCPCS | High | Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion |
| Q2049-HCPCS | Moderate | Injection, doxorubicin hydrochloride, liposomal, imported Lipodox, 10 mg |
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.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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