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HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

HCPCS Level II code Q5098 designates the biosimilar product ustekinumab-srlf (imuldosa) for injection, billed per 1 mg. This code enables standardized reporting and billing for a biosimilar monoclonal antibody therapy used in immunologic and inflammatory conditions where ustekinumab is indicated. Nationally, adoption of biosimilar billing codes like Q5098 affects payer formularies, contracting, and reimbursement pathways for high-cost biologic treatments.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and service setting, commonly observed payer coverage patterns, and benchmarking elements relevant to billing and reimbursement. The publication also outlines typical places of service and what to expect when submitting claims for a biosimilar product billed per milligram.

This resource is intended to inform billing managers, revenue cycle staff, and policy analysts about the role of HCPCS Level II code Q5098 in claims processing, payer interactions, and clinical documentation workflows. Data not available in the input.

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Billing Code Overview

HCPCS Level II code Q5098 represents the drug product ustekinumab-srlf (imuldosa), biosimilar, billed per 1 mg for injection. The service type is injectable biologic medication administration intended for subcutaneous or intravenous use depending on clinical protocol for the referenced biologic formulation. The typical site of service for this medication is outpatient infusion centers, hospital outpatient departments, ambulatory clinics, and physician offices where biologic injections or infusions are administered.

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HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

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Billing Code Overview

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with moderate-to-severe plaque psoriasis or active Crohn disease who requires subcutaneous biologic therapy with ustekinumab biosimilar Q5098 (imuldosa). The patient presents to an infusion suite, ambulatory infusion center, specialty clinic, or physician office for administration of a prefilled syringe or vial-converted dose. Prior to injection, the clinician verifies the patient’s identity, reviews current medications and recent laboratory monitoring (for example, tuberculosis screening and baseline complete blood count), confirms dosing based on weight and indication, documents informed consent and prior authorization coverage, and inspects the drug carton for product, lot, and expiration. The healthcare professional prepares the syringe in a clean area, administers the subcutaneous injection into the abdomen, thigh, or upper arm, observes the patient for immediate adverse reaction per facility protocol (typically 15–30 minutes), documents lot number and injection site, and schedules follow-up dosing and monitoring. Typical sites of service include outpatient physician offices (dermatology, gastroenterology), ambulatory infusion centers, and specialty pharmacy administered injection clinics.

Coding Specifications

Modifier	Description	When to Use
`00`	Unmodified service	When no modifier applies to the administration claim for `Q5098`.
`22`	Increased procedural services	For unusually complex administration requiring substantially greater resources (document reason and supporting record).
`23`	Unusual anesthesia	Rare for subcutaneous injection; use if general anesthesia or deep sedation is required for administration.
`52`	Reduced services	When a planned full administration is partially reduced or not completed.
`53`	Discontinued procedure	If administration was started but stopped for clinical reasons before completion.
`62`	Two surgeons	If two practitioners with different specialties are jointly required for administration (rare).
`78`	Unplanned return to operating/procedure room	If patient requires unplanned return to procedure area for complication from the injection.
`80`	Assistant surgeon	If an assistant surgeon participates in a procedure-related event requiring reporting (rare for SC injection).
`82`	Assistant surgeon (when qualified resident not available)	Use when assistant surgeon provided and resident unavailable.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare	When those clinicians bill under their own NPI for administration-related services per payer policy.
`JW`	Drug or biological amount discarded/not administered to patient	When part of the single-use vial or syringe is discarded and must be reported for billing or inventory reconciliation.
`QX`	CRNA service with medical direction by physician	If a certified registered nurse anesthetist provides anesthesia services during administration under supervision.
`QY`	Medical direction of one CRNA by a physician	When a physician directs a CRNA during anesthesia for the procedure.
`TG`	Graduate medical education - primary care exception	When applicable for teaching hospital billing for resident involvement.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Dermatology	Dermatologists frequently initiate and supervise ustekinumab therapy for psoriasis and related skin disorders.
`207RG0400X`	Gastroenterology	Gastroenterologists manage ustekinumab for Crohn disease and ulcerative colitis.
`363LF0000X`	Allergy & Immunology	Allergists/immunologists may prescribe and monitor biologic therapy for immune-mediated diseases.
`185H00000X`	Internal Medicine	Primary care/internal medicine physicians may coordinate specialty biologic therapy and follow-up.
`261QM0800X`	Nurse Practitioner	Nurse practitioners commonly provide injections and ongoing administration in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L40.0`	Psoriasis vulgaris	Primary diagnosis for patients receiving ustekinumab for moderate-to-severe plaque psoriasis.
`L40.9`	Psoriasis, unspecified	Used when the specific psoriasis subtype is not otherwise specified but biologic therapy is indicated.
`K50.90`	Crohn disease, unspecified, without complications	Common gastroenterology indication for ustekinumab therapy in adults.
`K51.90`	Ulcerative colitis, unspecified, without complications	Indication for ustekinumab when used to treat moderate-to-severe ulcerative colitis.
`M32.9`	Systemic lupus erythematosus, unspecified	Autoimmune conditions occasionally assessed when considering immunosuppressive biologic therapy; requires careful assessment prior to initiation.
`L40.8`	Other psoriasis	Alternate code for less common psoriasis variants treated with biologics.
`Z79.899`	Other long term (current) drug therapy	May be used to indicate ongoing biologic therapy on the medication list and problem list.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly reported when a non-chemotherapy biologic like ustekinumab biosimilar is administered by injection in the office.
`36415`	Collection of venous blood by venipuncture	Performed prior to or during initiation for baseline labs and therapeutic monitoring.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for routine follow-up visits associated with ongoing biologic therapy management.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3–10 minutes	Example of an adjunct preventive counseling service that may be billed at the same visit when applicable.
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the service	Used to bill for additional disposable supplies needed for administration when payor policy allows.

HCPCS Level II Q4139: Injectable Amniomatrix or Biodmatrix, 1 cc

HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

HCPCS Level II Q4256: Area-Based Procedural Add-On, Per sq cm

HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

HCPCS Level II Q5132: Adalimumab-afzb (Abrilada) 10 mg Injection

HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

HCPCS Q0035: Cardiokymography, Cardiac Motion Recording

HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

HCPCS Q0081: Infusion Therapy, Non-Chemotherapeutic, Per Visit

HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

HCPCS Q0083: Chemotherapy Administration, Non-Infusion

HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

HCPCS Q0085: Chemotherapy Administration, Infusion Plus Other Technique(s) per Visit

HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

HCPCS Q0091: Screening Pap Smear Specimen Collection and Transport

HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

HCPCS Q0092: Set-up of Portable X-Ray Equipment

Showing 1–10 of 629

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Unmodified service	When no modifier applies to the administration claim for `Q5098`.
`22`	Increased procedural services	For unusually complex administration requiring substantially greater resources (document reason and supporting record).
`23`	Unusual anesthesia	Rare for subcutaneous injection; use if general anesthesia or deep sedation is required for administration.
`52`	Reduced services	When a planned full administration is partially reduced or not completed.
`53`	Discontinued procedure	If administration was started but stopped for clinical reasons before completion.
`62`	Two surgeons	If two practitioners with different specialties are jointly required for administration (rare).
`78`	Unplanned return to operating/procedure room	If patient requires unplanned return to procedure area for complication from the injection.
`80`	Assistant surgeon	If an assistant surgeon participates in a procedure-related event requiring reporting (rare for SC injection).
`82`	Assistant surgeon (when qualified resident not available)	Use when assistant surgeon provided and resident unavailable.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare	When those clinicians bill under their own NPI for administration-related services per payer policy.
`JW`	Drug or biological amount discarded/not administered to patient	When part of the single-use vial or syringe is discarded and must be reported for billing or inventory reconciliation.
`QX`	CRNA service with medical direction by physician	If a certified registered nurse anesthetist provides anesthesia services during administration under supervision.
`QY`	Medical direction of one CRNA by a physician	When a physician directs a CRNA during anesthesia for the procedure.
`TG`	Graduate medical education - primary care exception	When applicable for teaching hospital billing for resident involvement.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Dermatology	Dermatologists frequently initiate and supervise ustekinumab therapy for psoriasis and related skin disorders.
`207RG0400X`	Gastroenterology	Gastroenterologists manage ustekinumab for Crohn disease and ulcerative colitis.
`363LF0000X`	Allergy & Immunology	Allergists/immunologists may prescribe and monitor biologic therapy for immune-mediated diseases.
`185H00000X`	Internal Medicine	Primary care/internal medicine physicians may coordinate specialty biologic therapy and follow-up.
`261QM0800X`	Nurse Practitioner	Nurse practitioners commonly provide injections and ongoing administration in outpatient settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`L40.0`	Psoriasis vulgaris	Primary diagnosis for patients receiving ustekinumab for moderate-to-severe plaque psoriasis.
`L40.9`	Psoriasis, unspecified	Used when the specific psoriasis subtype is not otherwise specified but biologic therapy is indicated.
`K50.90`	Crohn disease, unspecified, without complications	Common gastroenterology indication for ustekinumab therapy in adults.
`K51.90`	Ulcerative colitis, unspecified, without complications	Indication for ustekinumab when used to treat moderate-to-severe ulcerative colitis.
`M32.9`	Systemic lupus erythematosus, unspecified	Autoimmune conditions occasionally assessed when considering immunosuppressive biologic therapy; requires careful assessment prior to initiation.
`L40.8`	Other psoriasis	Alternate code for less common psoriasis variants treated with biologics.
`Z79.899`	Other long term (current) drug therapy	May be used to indicate ongoing biologic therapy on the medication list and problem list.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly reported when a non-chemotherapy biologic like ustekinumab biosimilar is administered by injection in the office.
`36415`	Collection of venous blood by venipuncture	Performed prior to or during initiation for baseline labs and therapeutic monitoring.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for routine follow-up visits associated with ongoing biologic therapy management.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3–10 minutes	Example of an adjunct preventive counseling service that may be billed at the same visit when applicable.
`99070`	Supplies and materials (except spectacles), provided by physician over and above those usually included with the service	Used to bill for additional disposable supplies needed for administration when payor policy allows.

HCPCS Level II Q4139: Injectable Amniomatrix or Biodmatrix, 1 cc

HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

HCPCS Level II Q4256: Area-Based Procedural Add-On, Per sq cm

HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

HCPCS Level II Q5132: Adalimumab-afzb (Abrilada) 10 mg Injection

HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

HCPCS Q0035: Cardiokymography, Cardiac Motion Recording

HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

HCPCS Q0081: Infusion Therapy, Non-Chemotherapeutic, Per Visit

HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

HCPCS Q0083: Chemotherapy Administration, Non-Infusion

HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

HCPCS Q0085: Chemotherapy Administration, Infusion Plus Other Technique(s) per Visit

HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

HCPCS Q0091: Screening Pap Smear Specimen Collection and Transport

HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

HCPCS Q0092: Set-up of Portable X-Ray Equipment

Showing 1–10 of 629

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

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Billing Code Overview

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HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

Sign up for hcpcs Q5098 policy alerts

Billing Code Overview

HCPCS Q5098: Ustekinumab-srlf (imuldosa) Biosimilar Injection, 1 mg

Sign up for hcpcs Q5098 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code Q5098 represent and how is it billed?

Where is Q5098 typically administered and what is the usual method of administration?

Which CPT codes are commonly reported alongside Q5098 for administration and associated services?

What modifiers should I consider when submitting an administration claim for Q5098?

Which payers are covered in this analysis and does the page provide reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code Q5098 represent and how is it billed?

Where is Q5098 typically administered and what is the usual method of administration?

Which CPT codes are commonly reported alongside Q5098 for administration and associated services?

What modifiers should I consider when submitting an administration claim for Q5098?

Which payers are covered in this analysis and does the page provide reimbursement rates?

References