Q5106 HCPCS code: Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Q5106 is the HCPCS Level II code for injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units. In 2024 Medicare paid an average of $5.69 per service for Q5106 across 2,651,134 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 60 per day on outpatient hospital claims. Medicare volume fell 49% from 2022 to 2024 (5,249,042 to 2,651,134 services). In 2024, about 3,452 clinicians billed Medicare for Q5106 for 11,597 beneficiaries; Florida, California, Texas accounted for 46% 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 | 2018-07-01 |
| Last action effective | 2020-01-01 |
Who bills Q5106 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,452 |
| Medicare beneficiaries | 11,597 |
| States with claims | 46 |
| Share of services in top 3 states (Florida, California, Texas) | 46% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5106, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,249,042 | 19,572 | $8.09 | $6.35 |
| 2023 | 3,461,791 | 15,047 | $7.73 | $6.07 |
| 2024 | 2,651,134 | 11,597 | $7.27 | $5.69 |
States with the most Q5106 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 562,322 | $5.76 |
| California | 359,256 | $5.71 |
| Texas | 287,443 | $5.66 |
| New Jersey | 227,687 | $5.73 |
| New York | 143,923 | $5.55 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 60 | Prescribing Information |
| practitioner claims | 60 | Prescribing Information |
Medicare policy articles for this code
- A56462: Billing and Coding: Erythropoiesis Stimulating Agents (ESA) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56795: Billing and Coding: Erythropoiesis Stimulating Agents (ESAs) (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B))
- A60381: Billing and Coding: Erythropoiesis Stimulating Agents (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,489 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 | 4 |
| B97.35 | Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere | 4 |
| D46.0 | Refractory anemia without ring sideroblasts, so stated | 4 |
| D46.1 | Refractory anemia with ring sideroblasts | 4 |
| D46.20 | Refractory anemia with excess of blasts, unspecified | 4 |
| D46.21 | Refractory anemia with excess of blasts 1 | 4 |
| D46.A | Refractory cytopenia with multilineage dysplasia | 4 |
| D46.B | Refractory cytopenia with multilineage dysplasia and ring sideroblasts | 4 |
| D46.C | Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality | 4 |
| D47.1 | Chronic myeloproliferative disease | 4 |
Showing 10 of 1,489. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5106
- 2018-07-01: Q5106 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 Q5106?
Q5106 is the HCPCS Level II code for injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units. Short descriptor: "Inj retacrit non-esrd use".
How much does Medicare pay for Q5106?
In 2024, the average Medicare payment was $5.69 per service (average allowed $7.27).
Does Medicare cover Q5106?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q5106?
Medicare policy articles that cite Q5106 list 1,489 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include B20 (Human immunodeficiency virus [HIV] disease), B97.35 (Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere), D46.0 (Refractory anemia without ring sideroblasts, so stated). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5106 can be billed per day?
60 on outpatient hospital claims; 60 on practitioner claims (NCCI medically unlikely edits).
Related Q51 codes
- Q5100 — Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5101 — Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
- 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
- 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 Q5106
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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.