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Fact Sheet

Immunosuppressive Drugs: Supply Fees Fact Sheet

This fact sheet provides guidance for billing supply fees for Immunosuppressive drugs.

Supply Fee HCPCS Codes

HCPCS Descriptor
Q0510 Pharmacy Supply Fee for Initial Immunosuppressive Drug(s), first month following transplant.
Q0511 Pharmacy Supply Fee for Oral Anti-Cancer, Oral Anti-Emetic or Immunosuppressive Drug(s); for the first prescription in a 30-Day period.
Q0512 Pharmacy Supply Fee for Oral Anti-Cancer, Oral Anti-Emetic or Immunosuppressive Drug(s); for a subsequent prescription in a 30-Day period.

Billing Rules

  • Bill supply fees only when the drug is covered under the Immunosuppressive Drugs LCD and Policy Article.
    • If Medicare denies the drug on the claim as non-covered, Medicare will also deny the supply fee as non-covered.
  • There is no separate coding or payment for a compounding fee.
  • Bill the supply fee on the same claim as the drug. If you submit the supply fee separately, Medicare will deny the supply fee for incorrect billing.

Units of Service

  • Q0510:
    • Bill 1 unit of service of Q0510 for first immunosuppressive drug following a transplant.
      • Example: If you dispense 3 drugs, bill 1 unit of service of Q0510 and 2 units of service of Q0512.
    • If more than 1 organ is transplanted at the same time (such as heart-lung transplant)
      • Medicare will only pay for 1 unit of service of Q0510.
    • If the beneficiary has another transplant later, Medicare will pay for another unit of service of code Q0510.
    • Only one single supplier will get paid for the Q0510 after each transplant.
      • Example: Beneficiary gets immunosuppressive drugs from 2 separate pharmacies. Medicare will only pay for 1 unit of service of Q0510.
    • If you bill more than 1 unit of service of Q0510 per transplant, Medicare will deny the extra units.
  • Q0511:
    • Bill 1 unit of service for the first covered immunosuppressive drug that you dispense in a 30-day or a 90-day period.
    • If a single pharmacy bills more than 1 unit of service of Q0511 per 30-day or 90-day period, Medicare will deny the excess units as incorrect coding.
    • If more than one pharmacy dispenses covered drugs during a 30-day or a 90-day period, Medicare covers 1 unit of service of Q0511 for each pharmacy.
  • Q0512:
    • Bill 1 unit of service for each subsequent covered immunosuppressive drug you dispense in a 30-day or 90-day period.

Other Rules

  • If you dispense 2 dosage strengths of the same drug on the same day, Medicare will cover 1 unit of service of the appropriate supply fee for each strength.
  • If the units of service of Q0511 or Q0512 exceed the number of drugs on the claim, Medicare will deny the excess units as not separately payable.

Tips to Avoid Common Errors

  • Incorrect HCPCS Billed
    • HCPCS codes must match the service you provide.
      • Q0510 is only for the first prescription after a transplant.
      • Q0511 is for the first prescription in a 30-day or 90-day period(per pharmacy).
      • Q0512 is for subsequent prescriptions in a 30-day or 90-day period.
  • Multiple Supply Fees
    • If you bill more than 1 supply fee for the same drug within a 30-day or 90-day period, Medicare will deny the extra supply fee(s).
    • If you dispense 2 different strengths of the same drug on the same day, bill a supply fee for each strength.
  • Related Drugs Not Included
    • Bill the supply fee on the same claim as the drug code.
  • Non-covered
    • If Medicare denies a drug as non-covered, Medicare will also deny the supply fee as non-covered.
  • How to Prevent Duplicate Denials
    • Use the myCGS® Web PortalExternal Website to check claim history to see which supply fees were already billed during the month.

Resources

Published: 02.19.2026

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