Summary & Overview
HCPCS Q2042: Tisagenlecleucel CAR T‑Cell Therapy Dose
HCPCS Level II code Q2042 identifies a single therapeutic dose of tisagenlecleucel—an autologous CAR T‑cell therapy—covering up to 600 million CAR‑positive viable T cells and including leukapheresis and dose preparation procedures. This coding captures the product and associated preparation steps used in advanced cellular immunotherapy for eligible hematologic malignancies and other approved indications, making it central to billing and access for high‑cost, one‑time curative‑intent treatments.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for CAR T therapy billing, typical sites of service where Q2042 is used, and the role of this code in reimbursement workflows. The publication also outlines benchmarking topics such as allowed amounts and payment variability, payer policy themes including coverage and prior authorization trends, and operational considerations for hospital and specialty infusion billing teams.
This summary is intended for revenue cycle, clinical leaders, and policy analysts who need a concise reference to the code’s clinical meaning, payer landscape, and the kinds of benchmarks and policy updates that affect billing and access for high‑cost cellular therapies.
Billing Code Overview
HCPCS Level II code Q2042 represents tisagenlecleucel, up to 600 million CAR‑positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose. This code describes a single therapeutic dose of an autologous CAR T‑cell therapy product that includes collection and preparation steps as part of the billed service.
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Service type: Cellular immunotherapy product administration with included leukapheresis and dose preparation
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Typical site of service: Hospital inpatient or outpatient specialty infusion center and accredited cellular therapy facilities
Data not available in the input for associated taxonomies, ICD‑10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual with relapsed or refractory B‑cell acute lymphoblastic leukemia (B‑ALL) or certain types of large B‑cell lymphoma who is a candidate for autologous, genetically modified CAR‑T cell therapy. The workflow begins with hematology/oncology evaluation, eligibility confirmation, and consent. The patient undergoes leukapheresis to collect peripheral blood mononuclear cells; cells are shipped to a manufacturing facility for genetic modification to produce tisagenlecleucel. During manufacturing the patient may receive bridging therapy. Prior to infusion the patient is admitted to an inpatient or specialized outpatient infusion center with trained staff for pre‑infusion assessment, lymphodepleting chemotherapy administration, and readiness checks. On infusion day the product labeled as Q2042 is delivered, dose verification and bedside preparation are performed by certified pharmacy/infusion nursing, and the therapeutic dose is infused over the prescribed time with continuous monitoring for acute toxicities such as cytokine release syndrome and neurotoxicity. Post‑infusion monitoring continues in a hospital or specialized infusion center for several days to weeks depending on clinical status, with scheduled follow‑up visits for response assessment and long‑term surveillance for B‑cell aplasia and other delayed effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |