ACTEMRA Q Code: 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
Q4 2026 Medicare Payment Limit for Q0249, effective October 1, 2026: $7.569 per HCPCS billing unit, unchanged from Q3 2026. From CMS's final file.
Drug & Product Overview
About ACTEMRA
Actemra is a medication aligned to the HCPCS Q Code: Q0249 for billing, pricing, and reimbursement purposes in the United States. It is a COVID-19 drug administered via the intravenous or subcutaneous routes and manufactured by multiple companies.
According to CMS Drug Use Information: This medication is used to treat rheumatoid arthritis in adults and in children (such as systemic juvenile idiopathic arthritis-SJIA, polyarticular juvenile idiopathic arthritis-PJIA). It helps to reduce pain and swelling due to rheumatoid arthritis. Tocilizumab can also be used to treat giant cell arteritis. It helps to reduce swelling in your blood vessels so blood can flow more easily. Tocilizumab may be used to treat a reaction (Cytokine Release Syndrome-CRS) caused by certain cancer treatments. Tocilizumab is also used in combination with a corticosteroid (such as dexamethasone) to treat coronavirus disease (COVID-19) in hospitalized patients who need supplemental oxygen (including patients on a mechanical ventilator). Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. It works by blocking IL-6, a substance made by the body that causes swelling (inflammation). This monograph is about the following tocilizumab products: tocilizumab, tocilizumab-aazg, tocilizumab-anoh, and tocilizumab-bavi.
Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.
NDC Code Information
5 NDC packages are crosswalked to Q0249. Package detail is available to logged-in subscribers.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
| •••••-••••-•• Log in to view | ACTEMRA | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
ACTEMRA Pricing & Reimbursement
National median reimbursement across major commercial payers.
Create an account on PayerPrice for more information →
Historical Graphing and Billing Calculator
Log in to calculate billing and reimbursement with live ASP, WAC & AWP pricing.
Login to use the calculator →ACTEMRA CPT Administration Codes
The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.
| CPT Code | Description |
|---|---|
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) |
| 96372 Login for More | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular Login for More |
CMS does not include Actemra (Q0249) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q0249. Wastage billing guide →
ACTEMRA Medically Unlikely Edits (MUE)
The most billing units of Q0249 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.
MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →
ACTEMRA Clinical Information
Indications and drug classification.
This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.
Login for BuyandBill.com Analytics
Unlock deeper insights with BuyandBill’s Comparative Report!
- Compare ASP, WAC, and AWP across drugs.
- Visualize Drug Price Movement Over Time
- Tailor reports to drug class, manufacturer, or HCPCS Code.
- Compare Biosimilar and 505(b)(2) products.
Frequently Asked Questions
Is there an available Actemra billing and coding guide?
Are there any available Actemra patient assistance programs?
Where can I find Actemra prescribing information?
Where can I find Actemra side effect information?
Does billing ACTEMRA require JZ/JW wastage modifiers?
About BuyandBill.com:
The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.
Related Drug Codes
Explore billing, coding, and pricing for drugs related to ACTEMRA.
