Summary & Overview
HCPCS Q4244: Procenta, 200 mg
HCPCS Level II code Q4244 designates Procenta, billed per 200 mg, and is used to document supply or administration of this specific medication formulation in outpatient settings. Nationally, drug-specific HCPCS codes matter for consistent claims processing, pricing transparency, and accurate tracking of utilization and spend for specialty therapies. HCPCS drug codes are commonly used by public and commercial payers for billing of infused or parenteral medications.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical scope, typical sites of service, common billing modifiers and workflow considerations, payer coverage context, and where to locate relevant policy references. The brief examines benchmark and reimbursement considerations at a national level and highlights documentation elements important for claim validation.
This publication provides practical coding context rather than clinical guidance, intended for billing managers, revenue cycle staff, and policy analysts who need a concise reference for HCPCS Level II code Q4244 and its role in outpatient medication billing.
Billing Code Overview
HCPCS Level II code Q4244 represents Procenta, billed per 200 mg. This code is used to report administration or provision of the specified medication formulation and strength.
Service Type: Pharmaceutical administration / Drug supply
Typical Site of Service: Outpatient infusion clinic, hospital outpatient department, physician office, or other outpatient settings where parenteral or infused medications are administered
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a documented chronic inflammatory or autoimmune condition (for example, rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis) who requires treatment with an interleukin-targeting biologic supplied as a vial of Procenta (per 200 mg). The clinical workflow begins with a specialty clinic or infusion/ambulatory infusion center visit where a prescribing rheumatologist or specialty nurse confirms diagnosis, documents prior therapies and labs, obtains informed consent, and orders the medication. Pharmacy verifies dose and prepares the 200 mg vial under sterile conditions. The patient may receive the product as an outpatient injection or supervised infusion depending on formulation and payer rules. Observation for infusion- or injection-related reactions follows administration, and the encounter is documented with medication lot number, route, dose, administration site, and any immediate adverse events. Billing uses HCPCS Level II code Q4244 with appropriate modifiers to reflect unusual services, payer-required circumstances, or provider/supplier arrangements.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |