2025 HCPCS code Q5110

1 mcg of Nivestym™ (filgrastim-aafi), a granulocyte colony-stimulating factor (G-CSF), administered via subcutaneous injection or intravenous infusion to stimulate granulocyte production.

Refer to HCPCS coding guidelines and individual payer guidelines for specific instructions on the use of this code, particularly regarding the separate coding of drug administration.

Modifiers may be applicable depending on the circumstances of administration (e.g., multiple injections, administration by a non-physician provider). Consult current modifier guidelines.

Medical necessity is established by the patient's underlying condition requiring G-CSF stimulation. This may include myelosuppressive chemotherapy, bone marrow transplantation, or severe neutropenia.Documentation should clearly demonstrate the clinical need for filgrastim-aafi based on established medical guidelines and clinical judgment.

The prescribing physician is responsible for determining the appropriate dose and administration method of filgrastim-aafi based on the patient's condition and medical history.Nursing staff or other qualified personnel may administer the medication under physician supervision.Appropriate documentation by both the physician and the administering personnel is essential for accurate billing and reimbursement.

IMPORTANT Do not use this code for other filgrastim or filgrastim biosimilar brand names.Separate codes may be necessary for administration depending on payer policies.

In simple words: This code covers a small amount (1 mcg) of a medicine called Nivestym, which helps the body fight infections by boosting white blood cell production.It's given as a shot or through an IV depending on the patient's needs.

This code represents 1 mcg of Nivestym™ (filgrastim-aafi), a granulocyte colony-stimulating factor (G-CSF), administered by subcutaneous (subcu) injection or intravenous (IV) infusion.It stimulates the bone marrow to produce granulocytes, white blood cells crucial for fighting infection. The recommended dosage varies depending on the indication (e.g., myelosuppressive chemotherapy, bone marrow transplantation, congenital neutropenia).The drug is supplied in single-dose vials or pre-filled syringes. This code represents the supply of the drug; separate coding may be required for administration, depending on payer guidelines.

Example 1: A patient undergoing myelosuppressive chemotherapy for acute myeloid leukemia receives Q5110 (Nivestym) to stimulate white blood cell production and reduce the risk of infection., A patient who has undergone an autologous bone marrow transplant for multiple myeloma receives Q5110 to support their immune system recovery., A patient with severe congenital neutropenia is prescribed Q5110 for long-term management of their condition.

Complete patient medical history, including diagnosis, treatment plan, and reason for filgrastim-aafi administration. Detailed records of the medication's dose, administration route (IV or subcutaneous), date, and time.Physician order specifying the dose and route of administration.Documentation of the patient's response to the medication.

** This code represents only the supply of the drug.Administration may require separate coding.Always refer to the most up-to-date HCPCS code set and individual payer guidelines for accurate billing and reimbursement.

  • Revenue Code: Further research is needed to determine the appropriate revenue codes.
  • RVU: RVUs are not directly assigned to HCPCS codes like Q5110. Reimbursement is determined by the payer and may be based on factors like acquisition cost, administration method, and the specific clinical scenario.Further research is needed to determine appropriate relative value units and relevant payment rates.
  • Global Days : Not applicable; this code represents drug supply, not a procedure with a global period.
  • Payment Status: Active
  • Modifier TC rule: A technical component (TC) modifier is not applicable to Q5110, as it represents drug supply, not a procedure with separate professional and technical components.
  • Fee Schedule : Fee schedules vary by payer and are subject to change. Consult payer-specific fee schedules for historical and current payment information.
  • Specialties:Oncology, Hematology, Infectious Disease
  • Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center
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