Q5111 — Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- When Neulasta® or UDENYCA® is administered by prefilled syringe, report the drug HCPCS code (J2506 or Q5111) and the administration CPT code 96372 in the medical record/claim.
- When Neulasta® or UDENYCA® is administered via an on-body injector (Neulasta® Onpro® or UDENYCA® ONBODY™), document and identify use of the on-body injector in the medical record and report CPT code 96377 (application of on-body injector).
- Document that the provider filled the injector device and applied it to the patient (provider does not inject the drug manually) when billing for on-body injector use.
- This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37176 for White Cell Colony Stimulating Factors; refer to LCD L37176 for specific coverage criteria, indications, and limitations.
Key Coverage Criteria
- Pegfilgrastim (Neulasta® or UDENYCA®) is covered to decrease the incidence of infection manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
- Pegfilgrastim (J2506) is indicated to decrease the incidence of infection manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia.
- Pegfilgrastim may be administered via prefilled syringe or via an on-body injector (e.g., Neulasta Onpro or UDENYCA ONBODY) as approved delivery methods.
- Same‑day administration (on the day of chemotherapy) may be allowed when patient or caregiver circumstances create a significant barrier to returning for next‑day dosing (for example, lack of transportation).
- - Adult AML shortly after completion of induction or repeat induction chemotherapy, or after consolidation chemotherapy for AML.
- - Treatment of severe neutropenia in hairy cell leukemia.
8 Active Policies
A54682 — Billing and Coding: Neulasta (pegfilgrastim) Onpro Kit / UDENYCA ONBODY (On-body Injector)
A56748 — Billing and Coding: White Cell Colony Stimulating Factors
A59126 — Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506
L37176 — White Cell Colony Stimulating Factors
CARELON-febrile-neutropenia-risk — Febrile Neutropenia Risk
Related Codes
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