Q5098 HCPCS code: Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
Q5098 is the HCPCS Level II code for injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 520 per day on DME suppliers.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2025-07-01 |
| Last action effective | 2025-07-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 520 | Prescribing Information |
| outpatient hospital claims | 520 | Prescribing Information |
| practitioner claims | 520 | Prescribing Information |
What changed for Q5098
- October 2025: Code appears in this HCPCS release
- 2025-07-01: Q5098 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q5098?
Q5098 is the HCPCS Level II code for injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg. Short descriptor: "Inj ustekinumab-srlf, 1 mg".
Does Medicare cover Q5098?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of Q5098 can be billed per day?
520 on DME suppliers; 520 on outpatient hospital claims; 520 on practitioner claims (NCCI medically unlikely edits).
Related Q50 codes
- Q5001 — Hospice or home health care provided in patient's home/residence
- Q5002 — Hospice or home health care provided in assisted living facility
- Q5003 — Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)
- Q5004 — Hospice care provided in skilled nursing facility (snf)
- Q5005 — Hospice care provided in inpatient hospital
- Q5006 — Hospice care provided in inpatient hospice facility
- Q5007 — Hospice care provided in long term care facility
- Q5008 — Hospice care provided in inpatient psychiatric facility
- Q5009 — Hospice or home health care provided in place not otherwise specified (nos)
- Q5010 — Hospice home care provided in a hospice facility
- Q5099 — Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg
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Next steps
- Run a reimbursement report for a device billed under Q5098
- Watch Q5098 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5098
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.