Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction
DME supplier: max 0 units per day (clinical), rationale: CMS Policy
Medicare pricing for Q0035
Physician Fee Schedule (CY 2026, RVU26D)
Status A: active, paid separately under the PFS if covered. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.
global: national non-facility $19.04, facility $19.04 (total RVUs 0.57 / 0.57 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)
professional component (26): national non-facility $8.02, facility $8.02 (total RVUs 0.24 / 0.24 × $33.4009 conversion factor)
technical component (TC): national non-facility $11.02, facility $11.02 (total RVUs 0.33 / 0.33 × $33.4009 conversion factor; facility NA: rarely or never done in that setting)
Payer policies and prior authorization for Q0035
Medicaid fee-for-service
Prior authorization required or conditional in IN.
AZ: $24.53 (outpatient_hospital), effective Oct 1, 2021
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.