2025 HCPCS code Q5111
(Active) Effective Date: N/A Revision Date: N/A Medication - Drugs Anti-Inflammatory Medication and Chemotherapy Medication Feed
This HCPCS code represents 0.5 mg of pegfilgrastim-cbqv (Udenyca), a biosimilar to pegfilgrastim, used to reduce infection risk in cancer patients undergoing chemotherapy.
Modifiers may apply depending on the administration method, discarded portions of the medication, and payer-specific rules.
Udenyca (pegfilgrastim-cbqv) is medically necessary for reducing the risk of febrile neutropenia in patients receiving myelosuppressive chemotherapy, based on established clinical guidelines and the patient's individual risk factors.
Oncologist or other qualified healthcare provider prescribing and/or administering the medication.Physician or other qualified healthcare professional responsible for patient assessment and treatment plan including monitoring for adverse effects.
In simple words: This code is for a 0.5 mg dose of the drug Udenyca, which helps protect cancer patients getting chemotherapy from getting serious infections.It's given as a shot under the skin.The doctor might bill separately for giving the shot.
HCPCS code Q5111 represents the supply of 0.5 mg of pegfilgrastim-cbqv (Udenyca®), a biosimilar to pegfilgrastim (Neulasta®).It's a leukocyte growth factor administered subcutaneously to decrease the incidence of febrile neutropenia in patients receiving myelosuppressive chemotherapy.Myelosuppressive chemotherapy reduces bone marrow activity, increasing infection susceptibility. Pegfilgrastim-cbqv stimulates neutrophil growth, bolstering the immune system.The recommended dose is 6 mg, supplied as a 6 mg/0.6 mL solution in a single-dose pre-filled syringe.Separate billing may apply for administration. Modifier JW might be used if a portion of the drug is discarded after partial administration, but payer guidelines should be checked.
Example 1: A patient with lymphoma receives myelosuppressive chemotherapy and is prescribed Udenyca to prevent neutropenic fever.Q5111 is reported for each 0.5 mg dose supplied., A patient with breast cancer undergoing chemotherapy develops neutropenia.The oncologist orders Udenyca to reduce the risk of infection.Q5111 is used to bill for the drug supplied.If administered via injection, an additional code for administration would be necessary (and might require different modifier)., A patient with leukemia receiving high-dose chemotherapy requires Udenyca prophylaxis. The pharmacist dispenses the medication, and Q5111 is reported for the total amount supplied.
Patient diagnosis of cancer requiring myelosuppressive chemotherapy; physician's order for pegfilgrastim-cbqv (Udenyca); documentation of the amount supplied;patient's weight and other relevant factors supporting medical necessity;documentation of any drug discarded (with modifier JW if applicable).
** This code represents only the supply of the drug.Separate billing for administration may be necessary, depending on payer guidelines.Always check payer specific guidelines for specific requirements before billing. The use of this medication should be in accordance with the manufacturer's instructions and prevailing medical standards.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier may be necessary depending on payer and facility policies.The use of TC modifiers is often dependent on whether the administration was done by the physician or a non-physician provider.
- Specialties:Oncology, Hematology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center, other appropriate settings.