Q5124 HCPCS code: Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
Q5124 is the HCPCS Level II code for injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg. In 2024 Medicare paid an average of $134.12 per service for Q5124 across 173,041 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 10 per day on outpatient hospital claims. Medicare volume rose 3504% from 2022 to 2024 (4,802 to 173,041 services). In 2024, about 399 clinicians billed Medicare for Q5124 for 6,435 beneficiaries; Maryland, Massachusetts, California accounted for 72% 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 | 2022-04-01 |
| Last action effective | 2023-01-01 |
Who bills Q5124 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 399 |
| Medicare beneficiaries | 6,435 |
| States with claims | 29 |
| Share of services in top 3 states (Maryland, Massachusetts, California) | 72% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5124, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,802 | 682 | $228.01 | $181.67 |
| 2023 | 149,705 | 6,803 | $214.98 | $170.85 |
| 2024 | 173,041 | 6,435 | $169.34 | $134.12 |
States with the most Q5124 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Maryland | 56,366 | $133.78 |
| Massachusetts | 44,658 | $134.47 |
| California | 23,339 | $135.08 |
| Texas | 8,052 | $133.06 |
| Tennessee | 6,415 | $133.72 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 10 | CMS Policy |
| practitioner claims | 10 | CMS Policy |
Medicare policy articles for this code
- A52451: Billing and Coding: Ranibizumab, Aflibercept and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (230 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 1 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 1 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | 1 |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | 1 |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | 1 |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | 1 |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye | 1 |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | 1 |
Showing 10 of 230. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5124
- 2022-04-01: Q5124 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 Q5124?
Q5124 is the HCPCS Level II code for injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg. Short descriptor: "Inj. byooviz, 0.1 mg".
How much does Medicare pay for Q5124?
In 2024, the average Medicare payment was $134.12 per service (average allowed $169.34).
Does Medicare cover Q5124?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5124?
Medicare policy articles that cite Q5124 list 230 covered ICD-10-CM diagnosis codes across 1 article. The most cited include E08.311 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema), E08.319 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema), E08.3211 (Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5124 can be billed per day?
10 on outpatient hospital claims; 10 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 Q5124
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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.