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Updated July 1st, 2026

PROVENGE Q Code: Q2043

Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion

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Q4 2026 Medicare Payment Limit for Q2043, effective October 1, 2026: $55,663.131 per HCPCS billing unit, down 0.5% from $55,932.427. From CMS's final file.

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Medicare Payment Limit ?
$55,932.427
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$55,932.427
/ HCPCS billing unit · APC 9273
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
HCPCS Added Date July 1, 2011
Manufacturer Dendreon Pharmaceuticals
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Form Injection

About PROVENGE

Provenge is a medication aligned to the HCPCS Q Code: Q2043 for billing, pricing, and reimbursement purposes in the United States. It is an Oncology drug administered via the intravenous route and manufactured by Dendreon Pharmaceuticals.

According to CMS Drug Use Information: This medication is used to treat advanced prostate cancer. Sipuleucel-T is a type of vaccine created from your own immune system cells that works by causing your immune system to attack prostate cancer cells. This requires that you have a procedure to remove some of your white blood cells, which are used to prepare sipuleucel-T. Talk to your doctor about the risks and benefits of this treatment.

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

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

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
30237-8900-06 Provenge Dendreon Pharmaceuticals LLC 1 Provenge Intravenous I njection 5000000… Login for More
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PROVENGE Pricing & Reimbursement

Q2043 Private Payer Reimbursement
$56,682.35 / 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

PROVENGE Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 37.76%
Avg. Days to File 27.0days
Avg. Days to Pay 40.1days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore Q2043 claims analytics on FocalPoint →
OnPoint Oncology

PROVENGE 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 Provenge (Q2043) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q2043. Wastage billing guide →

PROVENGE Medically Unlikely Edits (MUE)

The most billing units of Q2043 Medicare will pay for one patient in one day, as published by CMS. 1 unit = per infusion (minimum 50 million cells).

Practitioner Office & Hospital Outpatient
1 unit / day
Same limit in both settings

MAI 2 · Date of Service Edit: Policy. Absolute per-day limit set by policy or regulation; units above it are not payable, and denials are not appealable on medical-necessity grounds. See all MUE limits →

PROVENGE 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.

Asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer
Drug Class
Autologous Cellular Immunotherapy [EPC]Cell-mediated Immunity [PE]CellsCulturedAutologous [EXT]LeukocytesMononuclear [CS]

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Frequently Asked Questions

Is there an available Provenge billing and coding guide?
Billing and coding information for PROVENGE can be found through Dendreon. Visit Here →
Are there any available Provenge patient assistance programs?
PROVENGE patient assistance information can be found through Dendreon. Visit Here →
Where can I find Provenge prescribing information?
PROVENGE prescribing information can be found at the link below: Visit Here →
Where can I find Provenge side effect information?
Information regarding PROVENGE's side effects can be found at MedlinePlus Visit Here →
Does billing PROVENGE require JZ/JW wastage modifiers?
CMS does not include PROVENGE (Q2043) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q2043. For more information, visit the link below.

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