US · guidance
CMS Pub. 100-04, ch. 32, § 280.4
Payment Method
Payment for PROVENGE® is as follows:
• TOBs 12X, 13X, 22X and 23X - based on the Average Sales Price (ASP) + 6%,
• TOB 85X – based on reasonable cost,
• TOBs 71X and 77X – based on all-inclusive rate.
For Medicare Part B practitioner claims, payment for PROVENGE® is based on ASP + 6%.
Contractors shall not pay separately for routine costs associated with PROVENGE®, HCPCS
Q2043, except for the cost of administration. (Q2043 is all-inclusive and represents all routine
costs except for its cost of administration).
History
(Rev. 2380, Issued: 01-06-12, Effective: 06-30-11, Implementation: 08-08-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2d236eb2ea51c20f930dec884b017c8e68e795820968286402ba0ba8bcab6d7a
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