Q5101 HCPCS code: Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
Q5101 is the HCPCS Level II code for injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram. In 2024 Medicare paid an average of $0.26 per service for Q5101 across 7,758,234 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1500 per day on outpatient hospital claims. Medicare volume fell 74% from 2022 to 2024 (29,475,987 to 7,758,234 services). In 2024, about 2,105 clinicians billed Medicare for Q5101 for 3,296 beneficiaries; California, Texas, Florida accounted for 50% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2015-07-01 |
| Last action effective | 2024-01-01 |
Who bills Q5101 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,105 |
| Medicare beneficiaries | 3,296 |
| States with claims | 33 |
| Share of services in top 3 states (California, Texas, Florida) | 50% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5101, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 29,475,987 | 9,431 | $0.27 | $0.21 |
| 2023 | 16,035,201 | 6,250 | $0.20 | $0.16 |
| 2024 | 7,758,234 | 3,296 | $0.33 | $0.26 |
States with the most Q5101 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,469,881 | $0.26 |
| Texas | 1,227,752 | $0.25 |
| Florida | 1,121,739 | $0.26 |
| New York | 444,573 | $0.26 |
| Nevada | 312,729 | $0.25 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1500 | Clinical: CMS Workgroup |
| practitioner claims | 1500 | Clinical: CMS Workgroup |
Medicare policy articles for this code
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (1,265 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.2 | Malignant neoplasm of external lip, unspecified | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C00.9 | Malignant neoplasm of lip, unspecified | 1 |
Showing 10 of 1,265. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5101
- 2015-07-01: Q5101 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 Q5101?
Q5101 is the HCPCS Level II code for injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram. Short descriptor: "Injection, zarxio".
How much does Medicare pay for Q5101?
In 2024, the average Medicare payment was $0.26 per service (average allowed $0.33).
Does Medicare cover Q5101?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q5101?
Medicare policy articles that cite Q5101 list 1,265 covered ICD-10-CM diagnosis codes across 1 article. The most cited include B20 (Human immunodeficiency virus [HIV] disease), C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5101 can be billed per day?
1500 on outpatient hospital claims; 1500 on practitioner claims (NCCI medically unlikely edits).
Related Q51 codes
- Q5100 — Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5102 — Injection, infliximab, biosimilar, 10 mg
- Q5103 — Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
- Q5104 — Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
- Q5105 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
- Q5106 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
- Q5107 — Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
- Q5108 — Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
- Q5109 — Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
- Q5110 — Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111 — Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
- Q5112 — Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg
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Next steps
- Run a reimbursement report for a device billed under Q5101
- Watch Q5101 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5101
Sources: CMS HCPCS Level II release October 2026; 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.