Tecartus (brexucabtagene autoleucel) — HCPCS Q2053
CareCost Estimate · CAR-T Billing Cheat Sheet
Kite Pharma (a Gilead company)
Autologous anti-CD19 CAR-T (CD28 costim) + T-cell enrichment · Single IV infusion
FACT-accredited center only
First CAR-T in MCL (July 24, 2020, ZUMA-2)
Reviewed: May 22, 2026
ASP: Q2 2026
GATE: FACT (or FACT-JACIE) accreditation + TECARTUS REMS certification (Kite, separate from Yescarta REMS) + indication gate: MCL = documented BTKi failure; adult B-ALL = age ≥18 + CD19+ B-precursor pathology. Missing any one = #1 cause of CAR-T claim denial.
The 5-stage Tecartus CAR-T workflow
- ApheresisCPT 38206 / 0540T
FACT center
- Manufacture~16-19 days
T-cell enrichment
- LymphodepleteMCL: Flu 30 + Cy 500 (d -5 to -3)
ALL: Flu 25 + Cy 900 (d -4 to -2)
- CAR-T infusionQ2053 + 0537T-0541T
MS-DRG 018
- CRS / ICANSTocilizumab J3262
Monitor / readmit
HCPCS
Q2053
1 unit = 1 therapeutic dose
Route
Single IV
MCL 2 x 10^6/kg; ALL 1 x 10^6/kg
Inpatient DRG
018
CAR-T Immunotherapy
Admin CPTs
0537T-0541T
Cat III CAR-T set
Q2 2026 ASP+6%
$489,290.601
per single dose
Codes & NDC
| HCPCS | Q2053 — "Brexucabtagene autoleucel, up to 200M autologous anti-CD19 CAR+ viable T cells, incl leukapheresis + dose prep, per therapeutic dose" |
|---|
| NDC | 71287-129-XX Kite labeler 71287 + product suffix 129; patient-specific lot suffix from chain-of-identity label |
|---|
| ICD-10-PCS | XW033C3 peripheral / XW043C3 central (common in B-ALL) — drives MS-DRG 018 |
|---|
| Indications | R/R MCL post-BTKi (ZUMA-2); Adult R/R B-precursor ALL (ZUMA-3, age ≥18) |
|---|
| Benefit | Medical (hospital buy-and-bill); REMS-restricted |
|---|
The 4-claim cadence
| Claim | Stage | Codes |
|---|
| A | Apheresis | 38206 or 0540T + 6A550Z2 (inpt) |
| B | Lymphodepletion | J9185 + J9070 + 96413/96415 (dose differs by indication) |
| C | CAR-T infusion | Q2053 + 0537T-0541T + XW033C3/XW043C3 |
| D | CRS readmit (if) | Principal manifestation DRG + D89.83x + G92.0x |
Encounter spans 4-6 weeks across 3-4 distinct claims. Vein-to-vein ~16-19 days (longer than Yescarta due to T-cell enrichment step). Document chain of identity on every claim file.
TECARTUS REMS & FACT — required
Closed distribution. All three layers must be in place before any apheresis:
- Facility on Kite Tecartus Treatment Center list (FACT or FACT-JACIE + CRS/ICANS capability + tocilizumab on hand)
- Prescriber completed TECARTUS REMS training + enrolled
- Pharmacy / cell lab verifies prescriber + facility cert before accepting cellular product
Common error: Yescarta certification does NOT auto-extend to Tecartus. Each Kite product has a separate REMS certification cycle. Verify Tecartus-specific Kite cert before scheduling Stage 1.
CD19 CAR-T disambiguation
| Brand | HCPCS | Primary indication |
|---|
| Tecartus (brexu-cel) | Q2053 | R/R MCL post-BTKi, adult R/R B-ALL |
| Yescarta (axi-cel) | Q2041 | R/R LBCL 2L+/3L+, R/R FL |
| Kymriah (tisa-cel) | Q2042 | Peds/young adult ALL (≤25), R/R DLBCL/FL |
| Breyanzi (liso-cel) | Q2054 | R/R LBCL, CLL, FL, MCL |
Q2053 vs Q2041 is the highest-frequency Kite confusion pair — both labeler 71287. Disambiguate by carton suffix: Tecartus 71287-129-XX vs Yescarta 71287-119-XX. Verify against chain-of-identity label.
ICD-10 — by indication
| Code | For |
|---|
C83.10-C83.19 | Mantle cell lymphoma (site-stratified) |
C91.00 | B-cell ALL, not in remission |
C91.02 | B-cell ALL, in relapse |
| Chart narrative | BTKi exposure (MCL) / age ≥18 + CD19+ flow (ALL) |
D89.831-D89.835 | CRS by grade (G1-G5) |
G92.0x | ICANS |
Z94.81 | BMT status (post-HSCT cases) |
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 (MCL) | Inpatient (21) or outpt (22) | MS-DRG 018 or APC 9248 |
| Stage 4 CAR-T (B-ALL) | Inpatient (21) — near-universal | MS-DRG 018 bundled |
| Stage 5 CRS readmit | Inpatient (21) | DRG by manifestation |
MS-DRG 016 ≠ 018. 016 = autologous BMT; 018 = CAR-T Immunotherapy. Confirm XW033C3/XW043C3 in current-FY grouper. B-ALL: inpatient by default regardless of payer outpatient policy (high CRS Grade 3+ ~26% in ZUMA-3).
Medicare & NTAP (FY 2026)
| Field | Value |
|---|
| Q2053 ASP+6% | $489,290.601 / single dose (Q2 2026) |
| MS-DRG 018 | Dedicated CAR-T Immunotherapy DRG (since FY 2021) |
| NTAP | Expired for Tecartus after FY 2023; 2021 B-ALL approval did not trigger new NTAP |
| Outpatient APC | APC 9248 historically; verify current OPPS Addendum B |
| NCD | NCD 110.24 (CAR-T) — covers both MCL + adult B-ALL |
Top denials — Tecartus-specific
| # | Reason |
|---|
| 1 | Non-FACT / non-Tecartus-REMS-certified center (Yescarta cert does not extend) |
| 2 | BTKi failure not documented (MCL ZUMA-2 gate) |
| 3 | Age + CD19+ not documented (adult B-ALL ZUMA-3 gate) |
| 4 | Prior therapy lines not satisfied |
| 5 | Wrong REMS letter (Yescarta REMS on a Tecartus claim) |
| 6 | Lymphodepletion regimen wrong for indication (MCL dose on ALL or vice versa) |
| 7 | CRS / ICANS not coded properly (especially in high-CRS B-ALL) |
| 8 | Wrong Q-code (Q2053 vs Q2041 — both Kite labeler 71287) |
| 9 | Wrong DRG (016 vs 018) |
| 10 | Outpatient pathway rejected for B-ALL |
Patient assistance — Kite Konnect
- Kite Konnect — benefits, PA, appeal, case mgmt; copay (commercial). Same hub as Yescarta.
- Gilead Advancing Access — free product for eligible uninsured / underinsured
- Foundations: PAN, HealthWell, LLS Co-Pay (open MCL + ALL funds quarterly)
- Travel grants available for patients >50-100 mi from FACT center; LLS travel grants for ALL
BOXED WARNING — CRS & ICANS: Tecartus shares Yescarta's CD28 high-CRS profile. MCL (ZUMA-2): ~91% any-grade, ~15% Grade 3+. B-ALL (ZUMA-3): ~89% any-grade, ~26% Grade 3+ — highest in CD19 class, driven by high circulating tumor burden. Tocilizumab (J3262) on hand mandatory; ICU backup required.