Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

Q5101 - Q5110  Biosimilar Drugs

Q5101
Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
shortInjection, zarxio
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1500.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH1500.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
DME0.03 Date of Service Edit: ClinicalPublished Contractor Policy
Q5102
Injection, infliximab, biosimilar, 10 mg
shortInj., infliximab biosimilar
Q5103
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
shortInjection, inflectra
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalPrescribing Information
OPH150.03 Date of Service Edit: ClinicalPrescribing Information
DME0.03 Date of Service Edit: ClinicalCMS Policy
Q5104
Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
shortInjection, renflexis
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalPrescribing Information
OPH150.03 Date of Service Edit: ClinicalPrescribing Information
DME0.03 Date of Service Edit: ClinicalCMS Policy
Q5105
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
shortInj retacrit esrd on dialysi
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA100.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH400.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
Q5106
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
shortInj retacrit non-esrd use
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA60.03 Date of Service Edit: ClinicalPrescribing Information
OPH60.03 Date of Service Edit: ClinicalPrescribing Information
Q5107
Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
shortInj mvasi 10 mg
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA170.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH170.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
DME0.03 Date of Service Edit: ClinicalCMS Policy
Q5108
Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg
shortInjection, fulphila
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA12.03 Date of Service Edit: ClinicalPrescribing Information
OPH12.03 Date of Service Edit: ClinicalPrescribing Information
Q5109
Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
shortInjection, ixifi, 10 mg
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA150.03 Date of Service Edit: ClinicalPrescribing Information
OPH150.03 Date of Service Edit: ClinicalPrescribing Information
DME0.03 Date of Service Edit: ClinicalCMS Policy
Q5110
Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
shortNivestym
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1500.03 Date of Service Edit: ClinicalPrescribing Information
OPH1500.03 Date of Service Edit: ClinicalPrescribing Information