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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q0513-pharmacy-dispensing-inhalation-drug-30-day
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    HCPCS Q0513: Pharmacy Dispensing Fee for Inhalation Drug(s), Per 30 Days

    HCPCS Level II code Q0513 describes a pharmacy dispensing fee for inhalation drug(s) billed per 30 days, representing the service of dispensing and associated pharmacy management for inhaled medications; service type: pharmacy dispensing of inhalation medication; typical site of service: outpatient pharmacy or clinic-associated pharmacy setting where a 30-day supply of inhalation therapy is provided.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult or pediatric individual with a chronic or acute respiratory condition requiring a prescribed inhalation medication delivered via metered-dose inhaler, nebulizer solution, or dry powder inhaler. The patient presents to an outpatient pharmacy after receiving a prescription from a primary care physician, pulmonologist, or emergency department clinician. The pharmacy processes the prescription, dispenses a 30-day supply of the inhalation drug, and applies the pharmacy dispensing fee represented by Q0513. Clinical workflow steps include prescription receipt, verification of the medication and dose, insurance eligibility and benefit checks, patient counseling on inhaler technique and device maintenance, labeling, and documentation of dispensing in the pharmacy record. This service commonly follows a clinical encounter coded for conditions such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis exacerbation, or acute bronchitis where inhaled therapy is indicated. The typical site of service is an outpatient retail or specialty pharmacy; dispensing may also occur in hospital outpatient pharmacies or clinic-based pharmacies that provide outpatient fills for a 30-day supply.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    94640Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., nebulizer therapy)Performed in-clinic or ED before a prescription is written; may precede outpatient dispensing of a related 30-day inhalation medication.
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon outpatient visit during which the prescriber assesses control of respiratory disease and writes prescriptions that result in dispensing Q0513.
    94664Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered-dose inhaler, or IPPB devicePharmacists or clinicians provide inhaler technique training often documented at the time of dispensing a 30-day inhalation supply.
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the serviceUsed when additional supplies (e.g., spacer device) are provided along with the inhalation medication; may impact billing when equipment is supplied.
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesUsed for more complex visits that may result in changes to medication regimens and subsequent pharmacy dispensing.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207RG0100XGastroenterology PhysicianAn internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    207LH0002XHospice and Palliative Medicine (Anesthesiology) PhysicianAn anesthesiologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This …
    2083T0002XMedical Toxicology (Preventive Medicine) PhysicianMedical toxicologists are physicians who specialize in the prevention, evaluation, treatment and monitoring of injury and illness from exposures to dr…
    204F00000XTransplant Surgery PhysicianA surgeon who specializes in transplant surgery.
    207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) PhysicianAn otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including…
    207VM0101XMaternal & Fetal Medicine PhysicianAn obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowle…

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    9 rows

    PolicyPayerEffective Date
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

    HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

    HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

    HCPCS Level II Q5132: Injection, adalimumab-afzb (Abrilada), 10 mg

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

    HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

    HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

    HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

    HCPCS Q0085: Chemotherapy Infusion Plus Other Technique(s), Per Visit

    HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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