HCPCS Q2043
Sipuleucel-t auto cd54+
No national payment amount
Status E is not separately payable under the PFS.
Does Medicare pay separately for HCPCS Q2043 in 2026?
Not at a published national rate. HCPCS Q2043 carries status E (excluded) in the Q3 2026 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. Treat the blank amount as unpriced, not as $0.
Common questions
Why is there no payment amount for Q2043?
Its status indicator is E (excluded). A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. 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 Q2043 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is E (excluded) — A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. See status indicators
- 68 codes can never be billed with Q2043 on the same date of service — NCCI denies those pairs even with a modifier. See billing together
- 104 codes pair with Q2043 only when modifier 59 (or XE, XS, XP, XU) documents a distinct service — billed together without one, a line of the pair denies. See billing together
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 Q2043 visit in patient-friendly terms?
In plain terms: Sipuleucel-t auto cd54+ You'll typically see HCPCS Q2043 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 Q2043 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 – present | E | — | — |
| Q2 2026 Mar 10, 2026 – Jun 29, 2026 | E | — | — |
| Q1 2026 Dec 29, 2025 – Mar 9, 2026 | E | — | — |
| Q4 2025 Sep 11, 2025 – Dec 28, 2025 | E | — | — |
| Q3 2025 Jun 5, 2025 – Sep 10, 2025 | E | — | — |
| Q2 2025 Jun 5, 2025 – Jun 4, 2025 | E | — | — |
| Q1 2025 Dec 23, 2024 – Jun 4, 2025 | E | — | — |
Billing together (NCCI edits)
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI) — hover a code to see how it's used.
Never billable with Q2043 on the same date of service
Showing 3 of 68 — search above to check a specific code.
No match in this list.
Billable with Q2043 only with modifier 59, XE, XS, XP, or XU
Showing 3 of 104 — search above to check a specific code.
No match in this list.
Did this answer your question about HCPCS Q2043?
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Source & method
This is computed from CMS's Medicare Physician Fee Schedule Q3 2026 release (schedule pfs, effective July 2026). 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 $33.4009 read from the same file, row 11, column 26.
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 Q3 2026 figures, even after a newer release lands.
HCPCS Q2043 Medicare Physician Fee Schedule rate (Q3 2026). Localis. https://localishealth.com/hcpcs/Q2043/2026/C