HCPCS Q0243
Casirivimab and imdevimab
No national payment amount
Status X is not separately payable under the PFS.
Did Medicare pay separately for HCPCS Q0243 in Q1 2025?
Not at a published national rate. HCPCS Q0243 carries status X (statutory exclusion) in the Q1 2025 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.
Common questions
Why is there no payment amount for Q0243?
Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for Q0243 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is X (statutory exclusion) — The statutory definition of physician services does not include this item. See status indicators
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill?
What is a Q0243 visit in patient-friendly terms?
In plain terms: Casirivimab and imdevimab You'll typically see HCPCS Q0243 on a bill or explanation of benefits (EOB) when a clinician performs or bills for this service.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
Rate history by release
National non-facility amount for Q0243 across quarterly releases.
Did this answer your question about HCPCS Q0243?
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Source & method
This is computed from CMS's Medicare Physician Fee Schedule Q1 2025 release (schedule pfs, effective January 2025). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. CMS owns the code description shown for HCPCS Level II codes. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them.
Conversion factor $32.3465 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q1 2025 figures, even after a newer release lands.
HCPCS Q0243 Medicare Physician Fee Schedule rate (Q1 2025). Localis. https://localishealth.com/hcpcs/Q0243/2025/A