Q5154 HCPCS code: Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg
Q5154 is the HCPCS Level II code for injection, omalizumab-igec (omlyclo), biosimilar, 5 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
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 | 2025-10-01 |
| Last action effective | 2025-10-01 |
Medicare policy articles for this code
- A52448: Billing and Coding: Omalizumab and biosimilar, OMLYCLO® (omalizumab-igec) (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (17 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| J33.0 | Polyp of nasal cavity | 1 |
| J45.40 | Moderate persistent asthma, uncomplicated | 1 |
| J45.41 | Moderate persistent asthma with (acute) exacerbation | 1 |
| J45.42 | Moderate persistent asthma with status asthmaticus | 1 |
| J45.50 | Severe persistent asthma, uncomplicated | 1 |
| J45.51 | Severe persistent asthma with (acute) exacerbation | 1 |
| J45.52 | Severe persistent asthma with status asthmaticus | 1 |
| L50.1 | Idiopathic urticaria | 1 |
| L50.6 | Contact urticaria | 1 |
| L50.8 | Other urticaria | 1 |
Showing 10 of 17. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5154
- October 2025: Code appears in this HCPCS release
- 2025-10-01: Q5154 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 Q5154?
Q5154 is the HCPCS Level II code for injection, omalizumab-igec (omlyclo), biosimilar, 5 mg. Short descriptor: "Inj, omlyclo, 5 mg".
Does Medicare cover Q5154?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5154?
Medicare policy articles that cite Q5154 list 17 covered ICD-10-CM diagnosis codes across 1 article. The most cited include J33.0 (Polyp of nasal cavity), J45.40 (Moderate persistent asthma, uncomplicated), J45.41 (Moderate persistent asthma with (acute) exacerbation). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
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 Q5154
- Watch Q5154 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5154
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.