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HCPCS Q9992 · Level II · Part B drug

HCPCS Q9992: Injection, buprenorphine extended-release (sublocade), greater than 100 mg

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 Q9992

Billing unit
Greater than 100 MG
Buprenorphine xr over 100 mg
ASP payment limit
$2,060.132
October 2026; -0.4% vs July 2026
Practitioner MUE
1
MAI 2
OPPS status
SI K
APC 9239
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS Q9992 is the Level II code for Injection, buprenorphine extended-release (sublocade), greater than 100 mg, billed per Greater than 100 MG. The Medicare Part B ASP payment limit for October 2026 is $2,060.132 per billing unit, down 0.4% from July 2026. The practitioner MUE allows up to 1 units per date of service (MAI 2). Under OPPS it carries status indicator K in APC 9239. Q9992 is billed in units of Greater than 100 MG; 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 ASP crosswalk maps 1 NDC to it, sold as Sublocade by Indivior Inc.. No current Billing and Coding Article lists Q9992, 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 Q9992 at $2,060.132 per Greater than 100 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $2,068.155 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q9992
QuarterPayment limitPerCoinsurance
October 2026$2,060.132Greater than 100 MG20%
July 2026$2,068.155Greater than 100 MG—
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 Q9992. Report the NDC in the claim's drug segment and bill the number of Q9992 units that equals the quantity administered divided by Greater than 100 MG; the last column gives units per full package.

NDCs that crosswalk to Q9992
NDCDrug nameLabelerPackage sizeBilling units / package
12496-0300-01SublocadeIndivior Inc.1.5 × 11

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q9992. For practitioners the limit is 1 unit per date of service with adjudication indicator 2, a date-of-service policy edit: the limit reflects CMS policy and units above it deny even if split across lines; appeals rarely succeed.

MUE values for Q9992 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q9992 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.

Q9992 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 Q9992 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, Q9992 carries status indicator K and is assigned to APC 9239, with a published national unadjusted payment of $2,068.16. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for Q9992 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 Q9992 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.

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Frequently asked questions — HCPCS Q9992

What does HCPCS code Q9992 describe?

Q9992 is defined by CMS as "Injection, buprenorphine extended-release (sublocade), greater than 100 mg". Each billing unit represents Greater than 100 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q9992 in October 2026?

The ASP-based payment limit is $2,060.132 per Greater than 100 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $2,068.155.

How many units of Q9992 can be billed per day?

The practitioner Medically Unlikely Edit is 1 units per date of service with adjudication indicator 2 (2 Date of Service Edit: Policy). MAI 2 edits are policy limits and are rarely overturned on appeal. CMS cites "Code Descriptor / CPT Instruction" as the rationale.

Which NDCs map to Q9992?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Sublocade (Indivior Inc.). For example NDC 12496-0300-01 is a 1.5 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into Q9992 units.

Does Q9992 have NCCI bundling edits?

No active practitioner PTP pairs list Q9992 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. 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.