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HCPCS Q4081 · Level II · Part B drug

HCPCS Q4081: Injection, epoetin alfa, 100 units (for esrd on dialysis)

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for Q4081

Billing unit
100 UNITS
Epoetin alfa, 100 units esrd
ASP payment limit
$0.667
October 2026; -3.1% vs July 2026
Practitioner MUE
100
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
1
2 states

TL;DR

HCPCS Q4081 is the Level II code for Injection, epoetin alfa, 100 units (for esrd on dialysis), billed per 100 UNITS. The Medicare Part B ASP payment limit for October 2026 is $0.667 per billing unit, down 3.1% from July 2026. The practitioner MUE allows up to 100 units per date of service (MAI 3). Under OPPS it carries status indicator N. Because the descriptor is specific to ESRD patients on dialysis, Medicare expects the drug inside the ESRD prospective payment bundle when furnished by the dialysis facility, and separate Part B billing applies only outside that setting. The ASP crosswalk maps 18 NDCs to it, sold as Epogen, Procrit by Amgen Inc, Janssen Products, LP. 1 Medicare coverage article lists the code across 2 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q4081 at $0.667 per 100 UNITS for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.688 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q4081
QuarterPayment limitPerCoinsurance
October 2026$0.667100 UNITS20%
July 2026$0.688100 UNITS—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 18 NDCs from 2 labelers to Q4081. Report the NDC in the claim's drug segment and bill the number of Q4081 units that equals the quantity administered divided by 100 UNITS; the last column gives units per full package.

NDCs that crosswalk to Q4081
NDCDrug nameLabelerPackage sizeBilling units / package
55513-0126-10EpogenAmgen Inc1 × 10200
55513-0126-20EpogenAmgen Inc1 × 10200
55513-0144-10EpogenAmgen Inc1 × 101000
55513-0148-10EpogenAmgen Inc1 × 10400
55513-0267-10EpogenAmgen Inc1 × 10300
55513-0267-20EpogenAmgen Inc1 × 10300
55513-0283-10EpogenAmgen Inc2 × 102000
55513-0283-20EpogenAmgen Inc2 × 102000
55513-0478-10EpogenAmgen Inc1 × 102000
55513-0478-20EpogenAmgen Inc1 × 102000
59676-0302-01ProcritJanssen Products, LP1 × 6120
59676-0303-01ProcritJanssen Products, LP1 × 6180
59676-0304-01ProcritJanssen Products, LP1 × 6240
59676-0310-01ProcritJanssen Products, LP1 × 6600
59676-0310-02ProcritJanssen Products, LP1 × 252500
59676-0312-04ProcritJanssen Products, LP2 × 4800
59676-0320-04ProcritJanssen Products, LP1 × 4800
59676-0340-01ProcritJanssen Products, LP1 × 41600

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q4081. 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 Q4081 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1003 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital4003 Date of Service Edit: ClinicalClinical: Data

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q4081 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.

Q4081 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists Q4081 in their HCPCS tables, covering 2 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing Q4081
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Erythropoiesis Stimulating Agents (ESA)CGS Administrators, LLCKY OHL34356

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q4081 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for Q4081 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 Q4081 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP 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.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS Q4081

What does HCPCS code Q4081 describe?

Q4081 is defined by CMS as "Injection, epoetin alfa, 100 units (for esrd on dialysis)". Each billing unit represents 100 UNITS, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q4081 in October 2026?

The ASP-based payment limit is $0.667 per 100 UNITS, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.688.

How many units of Q4081 can be billed per day?

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

Which NDCs map to Q4081?

The October 2026 ASP crosswalk lists 18 NDCs from 2 labelers: Epogen (Amgen Inc); Procrit (Janssen Products, LP). For example NDC 55513-0126-10 is a 1 package equal to 200 billing units. The crosswalk's billing-units-per-package figure converts each package into Q4081 units.

Does Q4081 have NCCI bundling edits?

No active practitioner PTP pairs list Q4081 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention Q4081?

1 current Billing and Coding Article in the Medicare Coverage Database list Q4081, covering 2 states: (Billing and Coding: Erythropoiesis Stimulating Agents (ESA)).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

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 and the Medicare Coverage Database. Payment limits 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.