Abecma (idecabtagene vicleucel) — HCPCS Q2055
CareCost Estimate · CAR-T Billing Cheat Sheet
Bristol-Myers Squibb (Celgene) / 2seventy bio
Autologous anti-BCMA CAR-T (NOT CD19) · Single BCMA-binding domain, 4-1BB costim · Single IV infusion
FACT-accredited center only
FIRST CAR-T for MM (Mar 26, 2021, KarMMa)
Reviewed: May 22, 2026
ASP: Q2 2026
GATE: FACT (or FACT-JACIE) accreditation + ABECMA REMS certification (BMS, separate from Carvykti/Janssen, Kite, AND even Breyanzi/BMS) + indication gate: 2L+ MM = triple-class exposed (IMiD + PI + anti-CD38, KarMMa-3); 4L+ MM = ≥4 prior lines incl. PI + IMiD + anti-CD38 (KarMMa). Missing any = #1 cause of Abecma claim denial.
The 5-stage Abecma CAR-T workflow
- ApheresisCPT 38206 / 0540T
FACT center
- Manufacture~4-6 weeks at BMS/2seventy bio
Single-domain BCMA CAR
- LymphodepleteFlu 30 + Cy 300 mg/m^2
days -5 to -3
- CAR-T infusionQ2055 + 0537T-0541T
Single bag, 150-450M cells (flat)
- CRS / ICANSToci J3262 acute
NO extended MNT surveillance
HCPCS
Q2055
BCMA (NOT CD19) · 1 unit = 1 dose
Route
Single IV bag
Patient-specific
Inpatient DRG
018
Outpatient APC ~10-20%
Admin CPTs
0537T-0541T
Cat III CAR-T set
Q2 2026 ASP+6%
$559,781.081
per single dose
Codes & NDC
| HCPCS | Q2055 — "Idecabtagene vicleucel, up to 510M autologous BCMA-directed CAR+ viable T cells, per therapeutic dose" |
|---|
| NDC | BMS/Celgene labeler family; patient-specific lot per chain-of-identity label |
|---|
| ICD-10-PCS | XW033C3 peripheral / XW043C3 central — drives MS-DRG 018 (inpatient only) |
|---|
| Indications | R/R MM 2L+ triple-class exposed (KarMMa-3, Apr 4, 2024); R/R MM 4L+ post-PI/IMiD/anti-CD38 (KarMMa, Mar 26, 2021 — FIRST CAR-T for MM) |
|---|
| Benefit | Medical (hospital buy-and-bill); REMS-restricted |
|---|
The 4-claim cadence (no surveillance tail)
| Claim | Stage | Codes |
|---|
| A | Apheresis | 38206 or 0540T + 6A550Z2 (inpt) |
| B | Lymphodepletion | J9185 30 mg/m^2 + J9070 300 mg/m^2 + 96413/96415 days -5 to -3 |
| C | CAR-T infusion | Q2055 x 1 unit + 0537T-0541T + XW033C3/XW043C3 |
| D | CRS readmit (if) | Principal manifestation DRG + D89.83x + G92.0x |
Encounter spans 6-10 weeks across 3-4 distinct index claims. Vein-to-vein ~4-6 weeks (faster than Carvykti's 5-7 weeks). No extended ≥1-year neuro surveillance tail (that is Carvykti-specific). Document chain of identity (BMS/Celgene labeler) on every claim file.
ABECMA REMS & FACT — required
Closed distribution. All three layers must be in place before any apheresis:
- Facility on BMS Abecma Treatment Center list (FACT or FACT-JACIE + CRS/ICANS capability + tocilizumab on hand)
- Prescriber completed ABECMA REMS training + enrolled
- Pharmacy / cell lab verifies prescriber + facility cert before accepting cellular product
Common error: Carvykti cert does NOT extend to Abecma. BMS administers its own REMS. Breyanzi cert (also BMS) does NOT extend to Abecma either — same hub (BMS Cell Therapy 360), different product certifications. Verify BMS Abecma-specific certification before Stage 1.
BCMA cellular therapy disambiguation
| Brand | HCPCS | Class & positioning |
|---|
| Abecma (ide-cel) | Q2055 | BCMA CAR-T, single binding, 4-1BB; 2L+ MM triple-class exposed; BMS/2seventy — FIRST CAR-T for MM |
| Carvykti (cilta-cel) | Q2056 | BCMA CAR-T, dual binding, 4-1BB; 2L+ MM lenalidomide-refractory; Janssen labeler 57894 |
| Tecvayli (teclistamab) | J9380 | BCMA x CD3 bispecific Ab; SC dosing; 4L+ MM; Janssen |
| Elrexfio (elranatamab) | J-code | BCMA x CD3 bispecific Ab; SC dosing; 4L+ MM; Pfizer |
Abecma was the FIRST CAR-T approved for multiple myeloma. NOT a CD19 CAR-T. Q2055 (BCMA) is NOT interchangeable with Q2041/Q2042/Q2053/Q2054 (CD19 for lymphoma/leukemia). Chain-of-identity label is authoritative for Q2055 vs Q2056.
ICD-10 — myeloma + Abecma-specific
| Code | For |
|---|
C90.00 | Multiple myeloma, not in remission (primary) |
C90.02 | Multiple myeloma in relapse (primary) |
| Chart narrative | Triple-class exposed (2L+) / 4L+ triple-class + 4 lines |
Z79.899 | Long-term drug therapy / prior CAR-T history |
Z94.84 | Stem cell transplant status (post-HSCT) |
D89.831-D89.835 | CRS by grade (G1-G5) |
G92.0x | ICANS (standard, no MNT extension) |
D76.1 / D76.2 | HLH / MAS (boxed warning) |
G20.A1/A2 (drug-induced Parkinsonism) is NOT typical for Abecma claims. Those codes are Carvykti-specific (MNT delayed toxicity). If they appear on an Abecma claim, audit for a Q2055/Q2056 mix-up.
Site of care & payment
| Stage | Setting / POS | Payment |
|---|
| Stage 1 Apheresis | HOPD (22) or office (11) at FACT center | OPPS APC or MPFS |
| Stage 3 Lympho | HOPD (22) or office (11) | APC + J-codes |
| Stage 4 CAR-T (default) | Inpatient (21) most common | MS-DRG 018 bundled |
| Stage 4 CAR-T (outpatient emerging) | HOPD (22) | OPPS APC 9248 + Q2055 line item |
| Stage 5 CRS readmit | Inpatient (21) | DRG by manifestation |
Abecma outpatient share ~10-20% (higher than Carvykti's single-digit share; lower than Breyanzi's ~30-50%) — no MNT monitoring complexity to constrain outpatient. MS-DRG 016 ≠ 018 (016 = autologous BMT). Confirm XW033C3/XW043C3 in current-FY grouper.
Medicare & NTAP (FY 2026)
| Field | Value |
|---|
| Q2055 ASP+6% | $559,781.081 / single dose (Q2 2026) |
| MS-DRG 018 | Dedicated CAR-T Immunotherapy DRG (since FY 2021) |
| NTAP | Original 2021 NTAP expired ~2024 (3-yr window); verify FY 2026 IPPS Final Rule for residual status |
| Outpatient APC | APC 9248 historically; verify current OPPS Addendum B |
| NCD | NCD 110.24 (CAR-T) — covers both Abecma indications |
Top denials — Abecma-specific
| # | Reason |
|---|
| 1 | Non-FACT / non-ABECMA-REMS-certified center (Carvykti AND Breyanzi cert do not extend) |
| 2 | 2L+: triple-class exposure not documented (#1 KarMMa-3 gate) |
| 3 | 4L+: PI / IMiD / anti-CD38 triple-exposure across ≥4 lines not documented |
| 4 | Wrong Q-code: Q2056 (Carvykti) on Abecma claim |
| 5 | Wrong Q-code: CD19 CAR-T code (Q2041-Q2054) on Abecma claim |
| 6 | Outpatient pathway denied (default = inpatient MS-DRG 018) |
| 7 | Lymphodepletion: Cy 500 mg/m^2 billed when Abecma uses 300 |
| 8 | Manufacturing failure / no product (do NOT bill Q2055) |
| 9 | NDC-not-found (escalate to medical drug review w/ BMS chain-of-identity doc) |
| 10 | Carvykti policy language applied (no neuro monitoring required, no lenalidomide-refractory gate — KarMMa-3 uses triple-class exposure) |
Patient assistance — BMS Cell Therapy 360
- BMS Cell Therapy 360 — benefits, PA, appeal, case mgmt; copay (commercial). Same hub as Breyanzi (the BMS CD19 CAR-T).
- BMS Patient Assistance Foundation — free product for eligible uninsured / underinsured
- Foundations: PAN, HealthWell, LLS Co-Pay (myeloma funds open quarterly)
- Travel grants via BMS Cell Therapy 360 + International Myeloma Foundation for patients >50-100 mi from FACT center
BOXED WARNING — CRS, ICANS, HLH/MAS, prolonged cytopenias, secondary malignancies: Standard CAR-T 30-day post-infusion monitoring. Abecma does NOT carry the delayed Parkinsonism/MNT signal that Carvykti does — no extended ≥1-year neuro surveillance required. Tocilizumab (J3262) on hand per REMS; ICU backup required. CRS ~85% any-grade, ~5% Grade 3+ in KarMMa.