Home › Drug Codes › Q Codes › Q0224 · Pemgarda
Updated July 1st, 2026

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

Login to unlock all benchmarks

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.

?
Medicare Payment Limit ?
$7,239.00
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
Not published
CMS publishes none for Q3 2026
ASP ?
$•••.••
Login to view
WAC · AWP ?
$•••.••
Login to view
NDCs Crosswalked ?
1
View NDC crosswalk →

Drug & Product Overview

HCPCS Descriptor 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
HCPCS Added Date March 22, 2024
Manufacturer Invivyd
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection

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.

Login to view 1 NDC package View pricing, complete NDC-to-HCPCS alignments, and package details.
Login →

Pemgarda Pricing & Reimbursement

Q0224 Private Payer Reimbursement
$7,048.55 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →
UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

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)
Not on the CMS JW / JZ list

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.

Practitioner Office & Hospital Outpatient
1 unit / day
= 4,500 mg per day

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 →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

Pemgarda 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.

pre-exposure prophylaxis of COVID-19

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 Pemgarda billing and coding guide?
Billing and coding information for Pemgarda can be found through Invivyd, Inc. Visit Here →
Are there any available Pemgarda patient assistance programs?
Pemgarda patient assistance information can be found through Invivyd, Inc. Visit Here →
Where can I find Pemgarda prescribing information?
Pemgarda prescribing information can be found at the link below: Visit Here →
Where can I find Pemgarda side effect information?
Our team did not identify a source of side effect information for Pemgarda.
Does billing Pemgarda require JZ/JW wastage modifiers?
CMS does not include Pemgarda (Q0224) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q0224. For more information, visit the link below.

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.