Summary & Overview
HCPCS Q4213: Ascent, 0.5 mg
HCPCS Level II code Q4213 designates a specific pharmaceutical product, “Ascent, 0.5 mg,” used in outpatient medication supply or administration. Nationally, drug-specific HCPCS Level II codes matter because they standardize billing for medications across payers, enable consistent tracking of utilization and spending, and affect patient access through coverage and prior authorization policies. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context of the product labeled by Q4213, typical sites of service where it is billed, and which major national payers cover it. The publication provides benchmarks and comparisons of payer coverage patterns, common billing modifiers associated with HCPCS drug supply, and policy developments that influence reimbursement and utilization management. It also outlines operational considerations for billing departments, such as service-line placement and documentation expectations. Where specific input data is missing, the report notes those gaps and focuses on available national-level issues relevant to providers, coders, and payers.
Billing Code Overview
HCPCS Level II code Q4213 represents Ascent, 0.5 mg, a specific pharmaceutical product formulation. The service type is pharmacy/drug administration or outpatient medication supply, reflecting the billing of a fixed-dose pharmaceutical item. The typical site of service is outpatient clinic or pharmacy dispensing, where the product is supplied to or administered for a patient during ambulatory care.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with opioid use disorder presenting to an outpatient addiction treatment clinic or a certified opioid treatment program for maintenance therapy. The clinician assesses appropriateness for buprenorphine treatment and selects a formulation and dose; Q4213 represents administration or supply of a 0.5 mg buprenorphine product branded as Ascent. The workflow includes intake assessment, verification of diagnosis (for example, opioid dependence), medication reconciliation, observed or take-home dosing per program policy, documentation of informed consent and treatment plan, verification of payor coverage, and recording of the medication HCPCS code Q4213 on the claim. Typical sites of service include outpatient clinic, ambulatory substance use treatment program, opioid treatment program, or pharmacy dispensing under a clinic billing arrangement. Common clinical interactions tied to this code include medication initiation or continuation visits, periodic monitoring visits for efficacy and adverse effects, and coordination of behavioral health services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard service | Use for routine claims when no special circumstances apply. |