2025 HCPCS code Q5108

This HCPCS code represents 0.5 mg of pegfilgrastim-jmdb (Fulphila), a biosimilar used to reduce infection risk in patients undergoing myelosuppressive chemotherapy.

Refer to the HCPCS coding guidelines and payer-specific guidelines for accurate reporting of Q5108. Consider payer requirements for modifiers and documentation.

Modifiers may be applicable depending on the circumstances of administration (e.g., JW for discarded portion, or payer-specific modifiers).Always check payer-specific instructions.

Medical necessity for Q5108 (Fulphila) is established by the patient's diagnosis, chemotherapy regimen, and the risk of developing serious infections due to chemotherapy-induced myelosuppression.The use should align with current clinical guidelines and the physician's clinical judgment.

Administration and monitoring of the patient receiving pegfilgrastim-jmdb (Fulphila).Ensuring proper dosage and addressing potential adverse effects are crucial clinical responsibilities.

IMPORTANT Related codes include other pegfilgrastim biosimilars with unique HCPCS codes such as Q5110, Q5111, and Q5120.

In simple words: This code is for a medicine called Fulphila, which helps your body fight infections.It's given as a shot, and is often used by people getting chemotherapy for cancer. This code represents a specific small amount (0.5mg) of the drug.

HCPCS code Q5108 represents the supply of 0.5 mg of pegfilgrastim-jmdb (Fulphila), a biosimilar to pegfilgrastim (Neulasta).It's a leukocyte growth factor administered subcutaneously to reduce the incidence of febrile neutropenia in patients receiving myelosuppressive chemotherapy.The recommended dose is 6 mg, requiring 12 units of Q5108 for billing.Modifier JW may be used if a portion of the single-dose container is discarded.This code is for the drug supply; separate codes may apply for administration.

Example 1: A patient with breast cancer receiving myelosuppressive chemotherapy is prescribed Fulphila to reduce the risk of neutropenic infection.Twelve units of Q5108 are billed to reflect the 6mg administered dose., A patient with lymphoma undergoing high-dose chemotherapy receives Fulphila prophylactically to minimize the risk of febrile neutropenia.The 6mg dose is administered, resulting in a claim including 12 units of Q5108., A patient receiving chemotherapy for multiple myeloma experiences a reduced white blood cell count.A physician orders Fulphila, and 6mg is administered, leading to a claim with 12 units of Q5108.Modifier JW is appended because a portion of the medication was discarded.

* Physician order for pegfilgrastim-jmdb (Fulphila).* Documentation of the patient's diagnosis and chemotherapy regimen.* Evidence of myelosuppression or risk of neutropenic infection.* Record of the amount of Fulphila administered (including any discarded portion).* Documentation of administration site and technique.

** This code is specific to the biosimilar Fulphila (pegfilgrastim-jmdb).Use of this code requires careful adherence to CMS guidelines, including specific billing unit (0.5mg) and potential use of modifiers.

  • Revenue Code: Revenue codes will vary depending on the place of service and payer.
  • RVU: RVUs are not directly assigned to HCPCS codes like Q5108; reimbursement is determined by payer-specific fee schedules.
  • Global Days : Not applicable; this code represents a drug supply, not a procedure with a global period.
  • Payment Status: Active
  • Modifier TC rule: Not applicable; this code represents drug supply.
  • Fee Schedule : Historical fee schedule data is not available in the given data; please refer to CMS fee schedules and payer-specific data.
  • Specialties:Oncology, Hematology
  • Place of Service:Hospital outpatient, Physician's office
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