Summary & Overview
HCPCS Q9992: Buprenorphine Extended-Release (Sublocade) Injection >100 mg
HCPCS Level II code Q9992 represents the injectable, extended-release formulation of buprenorphine (Sublocade) in doses greater than 100 mg. This code captures administration of a long-acting medication used in opioid use disorder treatment and is relevant for payers and providers managing medication-assisted therapy across outpatient and ambulatory settings. Nationally, accurate use of this HCPCS code supports appropriate claim adjudication, coverage determination, and utilization tracking for a high-cost specialty medication that impacts addiction treatment programs and patient continuity of care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code denotes, common billing contexts, and the payer landscape addressed. The publication provides benchmarks and coverage context where available, notes common clinical settings for administration, and summarizes policy and coding considerations that affect claims processing for extended-release buprenorphine injections. If specific payer policies, coverage limits, or reimbursement benchmarks are not supplied in the source, those data points are identified as not available in the input.
Billing Code Overview
HCPCS Level II code Q9992 describes injection, buprenorphine extended-release (Sublocade), greater than 100 mg. This code represents administration of a long-acting, extended-release formulation of buprenorphine used in the treatment of opioid use disorder.
Service Type: Medication administration (injectable, extended-release)
Typical Site of Service: Outpatient clinic or ambulatory care setting where specialty injections are administered
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient with opioid use disorder (OUD) stabilized in an outpatient addiction medicine clinic presents for a scheduled monthly long-acting buprenorphine injection. The medication indicated is subcutaneous extended-release buprenorphine, delivered as an injection greater than 100 mg (Q9992). The care team includes an addiction medicine physician or advanced practice clinician, a registered nurse who administers the subcutaneous injection in the abdominal wall, and clinic staff who verify prior authorization, document medication lot and expiration, and provide post-injection observation for 15–30 minutes for adverse reactions. The clinical workflow begins with evaluation of adherence and stability, confirmation of diagnosis and eligibility, verification of payer coverage and any prior authorization requirements, informed consent, documentation of baseline vitals and allergy status, preparation of the sterile injection, administration in a private treatment room, documentation of the drug name and Q9992 billing code, and submission of the claim with any applicable modifier to reflect circumstances (for example, billing a modifier for services rendered by a non-physician practitioner or for partial administration). Follow-up scheduling is arranged for the next monthly injection and monitoring of treatment response and adverse effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |