Q1004 — New technology intraocular lens category 4 as defined in federal register notice
Q1004 is a HCPCS Level II code for new technology intraocular lens category 4 as defined in federal register notice. 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 Q1004 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
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
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 Q1004
- Long descriptor
- New technology intraocular lens category 4 as defined in federal register notice
- Short descriptor
- Ntiol category 4
- Added
- July 1, 1999
- BETOS
- D1F
- Pricing indicator
- 57 — 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.
Other carrier priced.
Codes adjacent to Q1004
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q1004 is not quite right, the correct code is very often within a few positions of it.
- 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
- Q0521Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription
- 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)
- Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
Questions about Q1004
What is HCPCS code Q1004?
Q1004 is a HCPCS Level II code for new technology intraocular lens category 4 as defined in federal register notice. It sits in the Temporary Codes section.
Does Medicare cover Q1004?
The CMS HCPCS file marks Q1004 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 Q1004 paid under the physician fee schedule?
Q1004 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.