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See a sample rate comparisonHCPCS Q9991 (Sublocade) 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.
Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Other Drugs and Test |
| Complexity Level | High |
| ASAM Level | Level 1 - Outpatient Services |
| Care Type | Medication Assisted Treatment |
| Setting | Outpatient |
| Medicaid Fee Schedule | View Medicaid rates for Q9991 |
| Medicare Payment Limit | $2016.423  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 12496-0100-01 - SUBLOCADE 100 MG/0.5 ML |
National average reimbursement for HCPCS Q9991 by major payers:
$1,847.78
$1,991.91
$2,075.28
$2,064.65
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HCPCS Q9991
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$4,315.43Published rateChristopher Raio
St Joseph Hospital
$2,000.34Published rateBama Heart Doc, P.C., Alabama Heart And Vascular Medicine
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$1,943.06Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$1,886.98Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$1,698.28Published rate
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See a sample payer proposalHCPCS Q9991 vs. Other Other Drugs and Test Codes
The HCPCS Q9991 code is part of the Temporary Codes services used for Other Drugs and Test. 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 Q9991 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 |
|---|---|---|
| 12496-0100-01-NDC | Moderate | SUBLOCADE 100 MG/0.5 ML |
| Q9983-HCPCS | High | Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries |
| Q9991-HCPCS | High | Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg |
| Q9992-HCPCS | High | Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q9991. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q9991 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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