Q5126 HCPCS code: Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg
Q5126 is the HCPCS Level II code for injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg. In 2024 Medicare paid an average of $45.56 per service for Q5126 across 1,234,339 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 230 per day on outpatient hospital claims. Medicare volume rose 66% from 2023 to 2024 (742,378 to 1,234,339 services). In 2024, about 1,322 clinicians billed Medicare for Q5126 for 2,816 beneficiaries; California, Florida, Illinois accounted for 28% 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 | O1D — Chemotherapy |
| Added | 2023-01-01 |
| Last action effective | 2023-01-01 |
Who bills Q5126 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,322 |
| Medicare beneficiaries | 2,816 |
| States with claims | 34 |
| Share of services in top 3 states (California, Florida, Illinois) | 28% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5126, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 742,378 | 2,190 | $67.81 | $54.03 |
| 2024 | 1,234,339 | 2,816 | $57.21 | $45.56 |
States with the most Q5126 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 158,820 | $45.32 |
| Florida | 96,910 | $45.71 |
| Illinois | 88,482 | $45.77 |
| Virginia | 78,546 | $45.78 |
| Maryland | 60,446 | $45.60 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 230 | CMS Policy |
| practitioner claims | 230 | CMS Policy |
Medicare policy articles for this code
- A52370: Billing and Coding: Bevacizumab and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (458 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C17.0 | Malignant neoplasm of duodenum | 1 |
| C17.1 | Malignant neoplasm of jejunum | 1 |
| C17.2 | Malignant neoplasm of ileum | 1 |
| C17.3 | Meckel's diverticulum, malignant | 1 |
| C17.8 | Malignant neoplasm of overlapping sites of small intestine | 1 |
| C17.9 | Malignant neoplasm of small intestine, unspecified | 1 |
| C18.0 | Malignant neoplasm of cecum | 1 |
| C18.1 | Malignant neoplasm of appendix | 1 |
| C18.2 | Malignant neoplasm of ascending colon | 1 |
| C18.3 | Malignant neoplasm of hepatic flexure | 1 |
Showing 10 of 458. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5126
- 2023-01-01: Q5126 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 Q5126?
Q5126 is the HCPCS Level II code for injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg. Short descriptor: "Inj alymsys 10 mg".
How much does Medicare pay for Q5126?
In 2024, the average Medicare payment was $45.56 per service (average allowed $57.21).
Does Medicare cover Q5126?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5126?
Medicare policy articles that cite Q5126 list 458 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C17.0 (Malignant neoplasm of duodenum), C17.1 (Malignant neoplasm of jejunum), C17.2 (Malignant neoplasm of ileum). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5126 can be billed per day?
230 on outpatient hospital claims; 230 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q5126
- Watch Q5126 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5126
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.