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HCPCS Q2009 · Level II · Part B drug

Q2009: fosphenytoin (Cerebyx), HCPCS Level II drug code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for Q2009

Billing unit
50 MG PE/ML
Fosphenytoin inj pe
OPPS payment rate
$1.552
no ASP limit; SI K, October 2026
Practitioner MUE
100
MAI 3
OPPS status
SI K
APC 9321
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS Q2009 is the Level II code for Injection, fosphenytoin, 50 mg phenytoin equivalent, billed per 50 MG PE/ML. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator K, $1.552 per billing unit in October 2026). The practitioner MUE allows up to 100 units per date of service (MAI 3). Q2009 is billed in units of 50 MG PE/ML; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The OPPS crosswalk maps 11 NDCs to it, sold as Cerebyx, Fosphenytoin Sodium by Pfizer Inc, Hikma Pharmaceuticals USA Inc., Sagent Pharmaceuticals. No current Billing and Coding Article lists Q2009, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare payment: OPPS rate (no ASP limit)

Q2009 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator K in APC 9321, at a national unadjusted rate of $1.552 per 50 MG PE/ML. Status K is a separately paid, non-pass-through drug or biological, including therapeutic radiopharmaceuticals. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk maps 11 NDCs from 5 labelers to Q2009. Report the NDC in the claim's drug segment and bill the number of Q2009 units that equals the quantity administered divided by 50 MG PE/ML; the last column gives units per full package.

NDCs that crosswalk to Q2009
NDCDrug nameLabelerPackage sizeBilling units / package
00069-5471-02CerebyxPfizer Inc2 × 2550
00069-5474-02CerebyxPfizer Inc10 × 10100
00069-6001-21CerebyxPfizer Inc10 × 10100
00069-6001-25CerebyxPfizer Inc2 × 2550
00641-6136-25Fosphenytoin SodiumHikma Pharmaceuticals USA Inc.2 × 2550
25021-0798-02Fosphenytoin SodiumSagent Pharmaceuticals2 × 2550
25021-0798-10Fosphenytoin SodiumSagent Pharmaceuticals10 × 10100
63323-0403-02Fosphenytoin SodiumFreseniUS Kabi USA, LLC2 × 2550
63323-0403-10Fosphenytoin SodiumFreseniUS Kabi USA, LLC10 × 10100
68462-0621-54Fosphenytoin SodiumGlenmark Pharmaceuticals Inc., USA2 × 2550
68462-0622-64Fosphenytoin SodiumGlenmark Pharmaceuticals Inc., USA10 × 10100

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q2009. For practitioners the limit is 100 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for Q2009 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalClinical: CMS Workgroup
Facility outpatient hospital1003 Date of Service Edit: ClinicalClinical: Data

MUE for Q2009 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q2009 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

The counts above are exposure, not answers for a specific claim. Check Q2009 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

Q2009 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists Q2009 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the October 2026 OPPS Addendum B, Q2009 carries status indicator K and is assigned to APC 9321, with a published national unadjusted payment of $1.552. Status K means the drug is paid separately under OPPS rather than packaged into the procedure.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), Q2009 carries payment indicator K2, which CMS defines as "Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate". The national ASC payment is $1.55 per 50 MG PE/ML, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for Q2009 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks Q2009 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS Q2009

What does HCPCS code Q2009 describe?

Q2009 is defined by CMS as "Injection, fosphenytoin, 50 mg phenytoin equivalent". Each billing unit represents 50 MG PE/ML, so the units reported on the claim must equal the dose administered divided by that unit.

Is Q2009 a CPT code?

No. Q2009 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as fosphenytoin (Cerebyx); CPT codes are five-character codes maintained by the AMA. On a Part B claim Q2009 reports the drug itself in 50 mg pe/ml units, and the administration is billed on its own line.

What does Medicare pay for Q2009 in a hospital outpatient department?

Q2009 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status K, APC 9321, at $1.552 per 50 MG PE/ML, and ASC Addendum BB gives it payment indicator K2 at $1.55.

How many units of Q2009 can be billed per day?

The practitioner Medically Unlikely Edit is 100 units per date of service with adjudication indicator 3 (Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: CMS Workgroup" as the rationale.

Which NDCs map to Q2009?

The October 2026 OPPS crosswalk lists 11 NDCs from 5 labelers: Cerebyx (Pfizer Inc); Fosphenytoin Sodium (Hikma Pharmaceuticals USA Inc.); Fosphenytoin Sodium (Sagent Pharmaceuticals); Fosphenytoin Sodium (FreseniUS Kabi USA, LLC). For example NDC 00069-5471-02 (package size 2) equals 50 billing units of Q2009.

Does Q2009 have NCCI bundling edits?

No active practitioner PTP pairs list Q2009 as a column-1 or column-2 code in the v323r0 release.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.