Q5122 HCPCS code: Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg
Q5122 is the HCPCS Level II code for injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg. In 2024 Medicare paid an average of $55.13 per service for Q5122 across 89,507 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 12 per day on outpatient hospital claims. Medicare volume fell 60% from 2022 to 2024 (222,702 to 89,507 services). In 2024, about 1,283 clinicians billed Medicare for Q5122 for 2,506 beneficiaries; Texas, Illinois, Virginia accounted for 35% of services.
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 | 2021-01-01 |
| Last action effective | 2023-04-01 |
Who bills Q5122 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,283 |
| Medicare beneficiaries | 2,506 |
| States with claims | 27 |
| Share of services in top 3 states (Texas, Illinois, Virginia) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5122, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 222,702 | 5,215 | $210.54 | $167.87 |
| 2023 | 257,374 | 5,990 | $114.88 | $91.30 |
| 2024 | 89,507 | 2,506 | $69.88 | $55.13 |
States with the most Q5122 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 11,358 | $52.70 |
| Illinois | 10,926 | $56.39 |
| Virginia | 8,184 | $52.53 |
| Maryland | 6,840 | $61.84 |
| South Carolina | 5,470 | $58.76 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Prescribing Information |
| practitioner claims | 12 | Prescribing Information |
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 Q5122
- 2021-01-01: Q5122 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 Q5122?
Q5122 is the HCPCS Level II code for injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg. Short descriptor: "Inj, nyvepria".
How much does Medicare pay for Q5122?
In 2024, the average Medicare payment was $55.13 per service (average allowed $69.88).
Does Medicare cover Q5122?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5122?
Medicare policy articles that cite Q5122 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 Q5122 can be billed per day?
12 on outpatient hospital claims; 12 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
- 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
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Next steps
- Run a reimbursement report for a device billed under Q5122
- Watch Q5122 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5122
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.