HCPCS Level II › Q codes Q2004 Bladder calculi irrig solIrrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
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: Prescribing Information Outpatient hospital: max 1 units per day (clinical), rationale: Prescribing Information Medicare pricing for Q2004 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for Q2004 Medicaid fee-for-service AZ: $101.19 (outpatient_hospital), effective Oct 1, 2025 KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $91.80 (professional_administered_drugs), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 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.