Q5128 HCPCS code: Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg
Q5128 is the HCPCS Level II code for injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg. In 2024 Medicare paid an average of $180.58 per service for Q5128 across 952,384 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 112% from 2023 to 2024 (449,065 to 952,384 services). In 2024, about 826 clinicians billed Medicare for Q5128 for 38,186 beneficiaries; Pennsylvania, California, Tennessee accounted for 45% 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 | 2023-04-01 |
| Last action effective | 2023-04-01 |
Who bills Q5128 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 826 |
| Medicare beneficiaries | 38,186 |
| States with claims | 39 |
| Share of services in top 3 states (Pennsylvania, California, Tennessee) | 45% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5128, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 449,065 | 28,127 | $272.05 | $216.74 |
| 2024 | 952,384 | 38,186 | $227.53 | $180.58 |
States with the most Q5128 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 194,200 | $180.16 |
| California | 122,993 | $180.27 |
| Tennessee | 110,809 | $180.49 |
| Texas | 103,147 | $180.42 |
| New York | 58,124 | $180.65 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 10 | Prescribing Information |
| practitioner claims | 10 | Prescribing Information |
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 Q5128
- 2023-04-01: Q5128 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 Q5128?
Q5128 is the HCPCS Level II code for injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg. Short descriptor: "Inj, cimerli, 0.1 mg".
How much does Medicare pay for Q5128?
In 2024, the average Medicare payment was $180.58 per service (average allowed $227.53).
Does Medicare cover Q5128?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5128?
Medicare policy articles that cite Q5128 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 Q5128 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 Q5128
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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.