2025 HCPCS code Q5127

Injection, pegfilgrastim-fpgk (Stimufend), biosimilar, 0.5 mg; a leukocyte growth factor used to reduce infection risk in patients undergoing myelosuppressive chemotherapy.

Consult CMS guidelines and payer-specific policies for coding this drug and its administration.

Modifiers may apply based on the administration method or circumstances. Refer to payer-specific guidelines.

Stimufend is medically necessary to reduce the risk of serious infection (febrile neutropenia) in patients undergoing myelosuppressive chemotherapy.The medical necessity should be documented in the patient's chart.

Oncologist or other qualified healthcare professional administering chemotherapy and managing the patient's infection risk.

IMPORTANT This code is a biosimilar to pegfilgrastim (Neulasta).Check payer guidelines to determine if separate codes are needed for administration.Modifier JW may be used if a partial dose is administered and the remainder discarded (payer guidelines should be consulted).

In simple words: This code is for a medicine called Stimufend, which helps prevent infections in people getting strong chemotherapy treatments for cancer.It's given as a shot under the skin. This code represents a portion of the total dose (0.5 mg).

This HCPCS code represents 0.5 mg of pegfilgrastim-fpgk (Stimufend), a biosimilar to pegfilgrastim (Neulasta). It's a leukocyte growth factor administered subcutaneously to reduce the risk of infection in patients receiving 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 covers the supply of the drug; separate codes may apply for administration.If a partial dose is used and the remainder discarded, modifier JW might be applicable (check payer guidelines).

Example 1: A patient with advanced breast cancer receiving dose-dense doxorubicin-based chemotherapy is prescribed Stimufend to reduce the risk of febrile neutropenia., A patient with lymphoma undergoing high-dose chemotherapy is given Stimufend prophylactically to minimize the chances of serious infection during the period of bone marrow suppression., A patient with multiple myeloma receiving bortezomib-based chemotherapy develops neutropenia; Stimufend is administered to boost their neutrophil count and enhance their immune response.

* Diagnosis codes for the underlying cancer.* Documentation of myelosuppressive chemotherapy regimen.* Justification for the use of pegfilgrastim-fpgk (e.g., high risk for febrile neutropenia).* Documentation of administration (if separate codes are used).* Evidence of medical necessity.

** Prior authorization may be required depending on payer policies.

  • Revenue Code: Unknown
  • RVU: Unknown
  • Global Days : Not applicable
  • Payment Status: Active
  • Modifier TC rule: Not applicable
  • Fee Schedule : Unknown
  • Specialties:Oncology, Hematology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Physician Office
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