2025 HCPCS code Q5120
(Active) Effective Date: N/A Revision Date: N/A Drugs - Pegfilgrastim Biosimilars Cancer and Vision Associated Drugs Feed
This code represents 0.5 mg of Ziextenzo (pegfilgrastim-bmez), a biosimilar to pegfilgrastim, used to reduce infection risk in cancer patients receiving myelosuppressive chemotherapy.
Modifiers may be applicable depending on the circumstances of administration. Refer to payer guidelines and NCCI edits for appropriate modifier usage.
Medical necessity is established by the presence of myelosuppressive chemotherapy causing neutropenia, placing the patient at high risk for severe infection.Ziextenzo is medically necessary to reduce this risk and improve the patient's outcome.
The clinical responsibility involves prescribing and monitoring the patient's response to pegfilgrastim-bmez therapy, including assessment of neutropenia, infection risk, and overall clinical status. The administration of the drug might be delegated to nursing staff.
In simple words: This code is for a medicine called Ziextenzo, a type of medication that helps people with cancer who are undergoing chemotherapy that weakens their bone marrow.Ziextenzo helps their bodies fight off infections.This code is for the medicine itself, not for giving the shot.
HCPCS code Q5120 represents the supply of 0.5 mg of pegfilgrastim-bmez (Ziextenzo®), a biosimilar to pegfilgrastim (Neulasta®).It's a leukocyte growth factor administered subcutaneously to decrease the incidence of febrile neutropenia in patients undergoing myelosuppressive chemotherapy.The recommended dose is 6 mg, supplied as a 6 mg/0.6 mL solution in a single-dose pre-filled syringe.This code is for the drug supply; separate codes may apply for administration.If only a portion of a single-dose container is used, modifier JW might be applicable (check payer guidelines).
Example 1: A 65-year-old female patient diagnosed with breast cancer is undergoing myelosuppressive chemotherapy. Her oncologist orders Ziextenzo (pegfilgrastim-bmez) to prevent febrile neutropenia. Code Q5120 is reported for each 0.5mg dose supplied., A 50-year-old male patient with lymphoma receiving aggressive chemotherapy experiences a significant drop in his neutrophil count.His physician prescribes Ziextenzo to mitigate the risk of infection.Q5120 is used to bill for the drug supply., A 70-year-old patient with leukemia receives a reduced dose of Ziextenzo due to kidney impairment.The physician documents the adjusted dosage, and Q5120 is reported accordingly, potentially with a modifier to specify the reduced dose.
* Physician's order for Ziextenzo (pegfilgrastim-bmez).* Patient's diagnosis of cancer and indication for myelosuppressive chemotherapy.* Documentation of absolute neutrophil count (ANC) indicating neutropenia.* Record of the administered dose of Ziextenzo (Q5120).* Any modifiers applied due to circumstances (e.g., JW for partial use of single-dose vial).
** Always refer to the most current payer guidelines for reimbursement policies and coding instructions. This information is for general guidance only and does not substitute for consulting official coding resources.
- Payment Status: Active
- Modifier TC rule: No Technical Component (TC) modifier applies to Q5120 as it represents drug supply, not administration.
- Fee Schedule : Fee schedules vary by payer. Consult the appropriate fee schedule for the relevant payer for the current and historical rates.The data for Q5120 will be available on the payer's fee schedule website or system.
- Specialties:Oncology, Hematology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgical Center