Home › Drug Codes › Q Codes › Q2042 · KYMRIAH
Updated July 1st, 2026

KYMRIAH Q Code: Q2042

Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose

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Q4 2026 Medicare Payment Limit for Q2042, effective October 1, 2026: $626,315.834 per HCPCS billing unit, up 2.4% from $611,693.171. From CMS's final file.

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Medicare Payment Limit ?
$611,693.171
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$611,693.171
/ HCPCS billing unit · APC 9194
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
2
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Drug & Product Overview

HCPCS Descriptor Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
HCPCS Added Date January 1, 2019
Manufacturer Novartis
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Form Injection, Suspension

About KYMRIAH

Kymriah is a medication aligned to the HCPCS Q Code: Q2042 for billing, pricing, and reimbursement purposes in the United States. This Oncology medication is administered via the intravenous route and manufactured by Novartis.

Manufacturers, reach out to us to add more information.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
00078-0846-19 Kymriah Novartis Pharmaceuticals Corporation 1 Kymriah Intravenous In jection 2000000 … Login for More
00078-0958-19 Kymriah Novartis Pharmaceuticals Corporation 1 Kymriah Intravenous In jection 60000000… Login for More
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KYMRIAH Pricing & Reimbursement

Q2042 Private Payer Reimbursement
$614,621.66 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

KYMRIAH 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
96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
Not on the CMS JW / JZ list

CMS does not include Kymriah (Q2042) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q2042. Wastage billing guide →

KYMRIAH Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

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.

Pediatric and Young Adult Relapsed or Refractory B-cell Acute Lymphoblastic Leukemia Adult Relapsed or Refractory Diffuse Large B-cell Lymphoma Adult Relapsed or Refractory Follicular Lymphoma
Drug Class
CD19 Receptor Interactions [MoA]CD19-directed Chimeric Antigen Receptor [EPC]CD19-specific Chimeric Antigen Receptor [CS]Genetically-modified Autologous T Cells [EPC]Increased T Lymphocyte Activation [PE]T LymphocytesCulturedAutologousGenetically-modified [EXT]

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Frequently Asked Questions

Is there an available Kymriah billing and coding guide?
Billing and coding information for KYMRIAH can be found through Novartis. Visit Here →
Are there any available Kymriah patient assistance programs?
KYMRIAH patient assistance information can be found through Novartis. Visit Here →
Where can I find Kymriah prescribing information?
KYMRIAH prescribing information can be found at the link below: Visit Here →
Where can I find Kymriah side effect information?
Information regarding KYMRIAH's side effects can be found at MedlinePlus Visit Here →
Does billing KYMRIAH require JZ/JW wastage modifiers?
CMS does not include KYMRIAH (Q2042) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q2042. For more information, visit the link below.

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