2025 HCPCS code Q5122

Injection, pegfilgrastim-apgf (Nyvepria), biosimilar, 0.5 mg.

Refer to the official HCPCS coding guidelines and payer-specific guidelines for detailed instructions.Payers may have specific requirements for documenting medical necessity and administration.

Modifiers may apply depending on the circumstances of administration or if a portion of the single-dose unit is used (e.g., modifier JW). Consult payer guidelines.

Pegfilgrastim-apgf (Nyvepria) is medically necessary for preventing febrile neutropenia in patients receiving myelosuppressive chemotherapy. The risk of severe infection is reduced, leading to improved patient outcomes and reduced healthcare costs associated with hospitalization for infection.

Oncologist or hematologist prescribes and monitors the patient's response to pegfilgrastim-apgf (Nyvepria). A nurse or other qualified healthcare professional administers the subcutaneous injection.

IMPORTANT May require additional codes for administration, depending on payer policy.Consider modifier JW if a portion of the single-dose container is discarded. Other pegfilgrastim biosimilars exist with separate HCPCS codes (e.g., Q5108, Q5111, Q5120, Q5127).

In simple words: This code is for a medicine called Nyvepria, a type of injection used to help prevent infections in cancer patients getting chemotherapy.The doctor uses this medicine to boost the body's ability to fight infection, as chemotherapy can weaken the immune system. The code is for a specific amount of the medicine (0.5 mg).

HCPCS code Q5122 represents 0.5 mg of pegfilgrastim-apgf (Nyvepria™), a biosimilar pegfilgrastim leukocyte growth factor.It's administered subcutaneously to reduce infection risk in patients undergoing myelosuppressive chemotherapy. The recommended dose is 6 mg subcutaneously, supplied as a 6 mg/0.6 mL solution in a single-dose pre-filled syringe.This code represents the supply of the drug; separate codes may be needed for administration, depending on payer guidelines. If only a portion of a single-dose container is used, modifier JW might apply (payer guidelines should be consulted).

Example 1: A 65-year-old male with acute myeloid leukemia (AML) receiving induction chemotherapy.The oncologist orders pegfilgrastim-apgf (Nyvepria) to prevent febrile neutropenia., A 48-year-old female with breast cancer undergoing dose-dense chemotherapy.The oncologist uses pegfilgrastim-apgf (Nyvepria) prophylaxis to manage the risk of neutropenia-related infections., A 72-year-old male with multiple myeloma receiving high-dose melphalan and autologous stem cell transplantation. Pegfilgrastim-apgf (Nyvepria) is used to accelerate neutrophil recovery post-transplant.

* Physician order specifying pegfilgrastim-apgf (Nyvepria).* Documentation of the patient's diagnosis (e.g., cancer type, stage, treatment regimen).* Evidence of myelosuppressive chemotherapy.* Record of administration (date, time, dose, route, site).* Progress notes reflecting the patient's response to therapy and any complications.

** Always verify payer specific coding and reimbursement policies before billing.This information is for guidance only and does not constitute medical or billing advice.

  • Payment Status: Active
  • Modifier TC rule: Not applicable. This HCPCS code represents the supply of the drug.
  • Fee Schedule : Fee schedules vary by payer and location. Check the current fee schedule for the relevant payer to determine reimbursement rates.
  • Specialties:Oncology, Hematology
  • Place of Service:Office, Hospital Outpatient, Hospital Inpatient
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