Q5125 HCPCS code: Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram
Q5125 is the HCPCS Level II code for injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram. In 2024 Medicare paid an average of $0.38 per service for Q5125 across 8,044,673 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 1800 per day on outpatient hospital claims. Medicare volume rose 159% from 2023 to 2024 (3,106,095 to 8,044,673 services). In 2024, about 1,310 clinicians billed Medicare for Q5125 for 2,677 beneficiaries; Florida, Texas, California accounted for 40% 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 | 2022-10-01 |
| Last action effective | 2022-10-01 |
Who bills Q5125 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,310 |
| Medicare beneficiaries | 2,677 |
| States with claims | 32 |
| Share of services in top 3 states (Florida, Texas, California) | 40% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5125, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 3,106,095 | 1,147 | $0.55 | $0.44 |
| 2024 | 8,044,673 | 2,677 | $0.48 | $0.38 |
States with the most Q5125 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 1,108,440 | $0.38 |
| Texas | 1,093,320 | $0.37 |
| California | 970,850 | $0.38 |
| Arkansas | 617,520 | $0.37 |
| Washington | 588,000 | $0.37 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1800 | Prescribing Information |
| practitioner claims | 1800 | 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 Q5125
- 2022-10-01: Q5125 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 Q5125?
Q5125 is the HCPCS Level II code for injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram. Short descriptor: "Inj, releuko 1 mcg".
How much does Medicare pay for Q5125?
In 2024, the average Medicare payment was $0.38 per service (average allowed $0.48).
Does Medicare cover Q5125?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5125?
Medicare policy articles that cite Q5125 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 Q5125 can be billed per day?
1800 on outpatient hospital claims; 1800 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 Q5125
- Watch Q5125 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5125
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.