Pemgarda Q Code: Q0224
Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg
Q4 2026 Medicare Payment Limit for Q0224, effective October 1, 2026: $7,615.20 per HCPCS billing unit, up 5.2% from $7,239.00. From CMS's final file.
Drug & Product Overview
About Pemgarda
Pemgarda is a medication aligned to the HCPCS Q Code: Q0224 for billing, pricing, and reimbursement purposes in the United States. This Anti-Anemia medication is administered via the intravenous route and manufactured by Invivyd.
According to CMS Drug Use Information: Pemivibart is a medication that the FDA is allowing to be given for emergency use to reduce the risk of getting COVID-19 infection in people who do not have COVID-19 and who have not been exposed to anyone with COVID-19. To receive this product, you must also have a weakened immune system because of certain conditions or medications (such as cancer, transplant), which reduces your response to the COVID-19 vaccine. It does not replace the COVID-19 vaccines. Talk to your doctor about the risks and benefits of treatment with pemivibart. This medication belongs to a class of drugs known as monoclonal antibodies. It works by preventing the COVID-19 virus from entering the cells in the body. This effect may prevent COVID-19. More information about pemivibart is available from the FDA Fact Sheet for Patients, Parents, and Caregivers for Emergency Use provided by your health care professional. If you are enrolled in a study, information should be provided by the doctor via the Informed Consent Form. There is limited information about how safe and effective pemivibart is for preventing COVID-19. This medication should not be used to treat COVID-19 or in people who have already been exposed to COVID-19. The information in this document reflects emerging data, which is evolving and subject to reassessment. Users should be aware of these considerations in their review of pemivibart, and it is always the responsibility of treating practitioners to exercise independent judgment in making care decisions.
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
1 NDC package is crosswalked to Q0224. Package detail is available to logged-in subscribers.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| •••••-••••-•• Log in to view | Pemgarda | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
Pemgarda Pricing & Reimbursement
National median reimbursement across major commercial payers.
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Login to use the calculator →Pemgarda 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) |
This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →
Pemgarda Medically Unlikely Edits (MUE)
The most billing units of Q0224 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 4500 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 →
Pemgarda 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.
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Frequently Asked Questions
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