Q0521 — Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
Q0521 is a HCPCS Level II code for pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription. It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
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 Q0521 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
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- DME supplier
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
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 Q0521
- Long descriptor
- Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
- Short descriptor
- Supply fee hiv prep fda appr
- Added
- January 1, 2025
- BETOS
- O1E
- Pricing indicator
- 46 — DMEPOS
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.
Carrier priced — not otherwise classified, individual determination, carrier discretion, or gap-filled amounts.
Codes adjacent to Q0521
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q0521 is not quite right, the correct code is very often within a few positions of it.
- Q0513Pharmacy dispensing fee for inhalation drug(s); per 30 days
- Q0514Pharmacy dispensing fee for inhalation drug(s); per 90 days
- Q0515Injection, sermorelin acetate, 1 microgram
- Q0516Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-daysterminated
- Q0517Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-daysterminated
- Q0518Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-daysterminated
- Q0519Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-daysterminated
- Q0520Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-daysterminated
- Q1004New technology intraocular lens category 4 as defined in federal register notice
- Q1005New technology intraocular lens category 5 as defined in federal register notice
- Q2004Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
- Q2009Injection, fosphenytoin, 50 mg phenytoin equivalent
- Q2017Injection, teniposide, 50 mgterminated
- Q2026Injection, radiesse, 0.1 ml
- Q2028Injection, sculptra, 0.5 mg
- Q2034Influenza virus vaccine, split virus, for intramuscular use (agriflu)
Questions about Q0521
What is HCPCS code Q0521?
Q0521 is a HCPCS Level II code for pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription. It sits in the Temporary Codes section.
Does Medicare cover Q0521?
The CMS HCPCS file marks Q0521 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is Q0521 paid under the physician fee schedule?
Q0521 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.