Q0234 Inj, tocilizumab-bavi, 1mg

Injection, tocilizumab-bavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, 1 mg

Medicare pricing for Q0234

Medicare Part B drug payment limit (ASP, October 2026)

Q0234 payment limit: $6.327 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%. Paid at 95% of AWP (vaccine). Note: See COVID-19 vaccine pricing webpage for payment effective dates.

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for Q0234

3 of 3 payer prior-auth lists that name Q0234 require prior authorization or set conditions: Cigna.

PayerPlanStatePrior authConditionsSinceSource
CignaACA/IFPAllprior auth requiredJul 1, 2026Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredJul 1, 2026Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredJul 1, 2026Master Precertification List (For Health Care Providers)

Payer coverage policies that name Q0234

Q0234 appears in 1 coverage policy from Blue Cross & Blue Shield of Rhode Island.

PayerPolicyRole in policyReviewedDocument
Blue Cross & Blue Shield of Rhode IslandCOVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications
Reimbursed | Reimbursed		listed, no stanceJun 11, 2026payer document

Medicaid fee-for-service

  • AZ: $6.33 (physician_administered_drugs), effective Jul 1, 2026
  • KS: $4.75 (default, Exempt Physician), effective Oct 1, 2026
  • MS: $6.33 (comprehensive), effective Jul 1, 2026
  • NE: $6.32 (injectables), effective Jul 1, 2026
  • OH: $6.33 (provider_administered_drugs), effective Jul 1, 2026
  • VT: $6.01 (outpatient_hospital_opps), effective Jul 1, 2026

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.