Q0249 — Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
Q0249 is a HCPCS Level II code for injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg. It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of Q0249 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1600 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 1600 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for Q0249
- Long descriptor
- Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
- Short descriptor
- Tocilizumab for covid-19
- Added
- June 24, 2021
- BETOS
- O1G
- Pricing indicator
- 54 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Vaccinations.
Codes adjacent to Q0249
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q0249 is not quite right, the correct code is very often within a few positions of it.
- Q0237Injection, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
- Q0238Injection, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
- Q0239Injection, bamlanivimab-xxxx, 700 mgterminated
- Q0240Injection, casirivimab and imdevimab, 600 mgterminated
- Q0243Injection, casirivimab and imdevimab, 2400 mgterminated
- Q0244Injection, casirivimab and imdevimab, 1200 mgterminated
- Q0245Injection, bamlanivimab and etesevimab, 2100 mgterminated
- Q0247Injection, sotrovimab, 500 mgterminated
- Q0477Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only
- Q0478Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type
- Q0479Power module for use with electric or electric/pneumatic ventricular assist device, replacement only
- Q0480Driver for use with pneumatic ventricular assist device, replacement only
- Q0481Microprocessor control unit for use with electric ventricular assist device, replacement only
- Q0482Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only
- Q0483Monitor/display module for use with electric ventricular assist device, replacement only
- Q0484Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only
Questions about Q0249
What is HCPCS code Q0249?
Q0249 is a HCPCS Level II code for injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg. It sits in the Temporary Codes section.
Does Medicare cover Q0249?
The CMS HCPCS file marks Q0249 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is Q0249 paid under the physician fee schedule?
Q0249 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.