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HCPCS Q9961 · Level II · Part B drug

HCPCS Q9961: High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml

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 Q9961

Billing unit
1 ML
Hocm 250-299mg/ml iodine,1ml
ASP payment limit
$0.205
October 2026; -8.5% vs July 2026
Practitioner MUE
200
MAI 3
OPPS status
SI N
NCCI exposure
2 col-2 pairs
100% allow a modifier
Coverage articles
0
none list this code

TL;DR

HCPCS Q9961 is the Level II code for High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml, billed per 1 ML. The Medicare Part B ASP payment limit for October 2026 is $0.205 per billing unit, down 8.5% from July 2026. The practitioner MUE allows up to 200 units per date of service (MAI 3). Under OPPS it carries status indicator N. Diagnostic agents are usually packaged under OPPS (status N) in the hospital outpatient setting, so separate payment applies mainly in the physician office under Part B. The ASP crosswalk maps 1 NDC to it, sold as Conray by Liebel-Flarsheim Company LLC. It is the bundled column-2 code in 2 NCCI pairs, most often with Q9962, Q9963. No current Billing and Coding Article lists Q9961, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q9961 at $0.205 per 1 ML for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.224 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q9961
QuarterPayment limitPerCoinsurance
October 2026$0.2051 ML20%
July 2026$0.2241 ML—
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 1 NDC from 1 labeler to Q9961. Report the NDC in the claim's drug segment and bill the number of Q9961 units that equals the quantity administered divided by 1 ML; the last column gives units per full package.

NDCs that crosswalk to Q9961
NDCDrug nameLabelerPackage sizeBilling units / package
00019-0953-05ConrayLiebel-Flarsheim Company LLC50 × 251250

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q9961. For practitioners the limit is 200 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 Q9961 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services2003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital2003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

In the practitioner PTP file v323r0 (effective October 1, 2026), Q9961 is the column-2 code in 2 active pairs, 100% of which allow a modifier (indicator 1), and the column-1 code in 8. 0 historical pairs have been deleted over time. CMS's most frequent rationale: Mutually exclusive procedures.

When billed with these column-1 codes, Q9961 is the bundled component unless the pair allows a modifier and the documentation supports a distinct service.

Column-1 codes most often paired with Q9961
Column-1 codePairs
Q9962 Hocm 300-349mg/ml iodine,1ml1
Q9963 Hocm 350-399mg/ml iodine,1ml1

These codes are considered components of Q9961 when reported together on the same date of service.

Column-2 codes most often bundled into Q9961
Column-2 codePairs
Q9951 Locm >= 400 mg/ml iodine,1ml1
Q9958 Hocm <=149 mg/ml iodine, 1ml1
Q9959 Hocm 150-199mg/ml iodine,1ml1
Q9960 Hocm 200-249mg/ml iodine,1ml1
Q9964 Hocm>= 400mg/ml iodine, 1ml1
Q9965 Locm 100-199mg/ml iodine,1ml1
Q9966 Locm 200-299mg/ml iodine,1ml1
Q9967 Locm 300-399mg/ml iodine,1ml1

Q9961 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 Q9961 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 July 2026 OPPS Addendum B, Q9961 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for Q9961 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 Q9961 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 Q9961

What does HCPCS code Q9961 describe?

Q9961 is defined by CMS as "High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml". Each billing unit represents 1 ML, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q9961 in October 2026?

The ASP-based payment limit is $0.205 per 1 ML, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.224.

How many units of Q9961 can be billed per day?

The practitioner Medically Unlikely Edit is 200 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 "Prescribing Information" as the rationale.

Which NDCs map to Q9961?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Conray (Liebel-Flarsheim Company LLC). For example NDC 00019-0953-05 is a 50 package equal to 1250 billing units. The crosswalk's billing-units-per-package figure converts each package into Q9961 units.

Does Q9961 have NCCI bundling edits?

In the v323r0 practitioner PTP file, Q9961 appears as the column-2 (bundled) code in 2 active pairs and as the column-1 code in 8. 100% of the column-2 pairs allow a modifier (indicator 1). The most frequent column-1 partners are Q9962, Q9963, and CMS's leading rationale is "Mutually exclusive procedures".

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.