Summary & Overview
HCPCS Q5105: Epoetin alfa-epbx (Retacrit) Injection, 100 Units
HCPCS Level II code Q5105 designates the injection of epoetin alfa-epbx (Retacrit), a biosimilar erythropoiesis-stimulating agent, in 100-unit increments for patients with end-stage renal disease on dialysis. This code captures delivery of a therapeutic biologic used to manage anemia related to chronic kidney disease and dialysis care. Nationally, use of biosimilar erythropoiesis-stimulating agents affects drug spending, formulary choices, and dialysis treatment protocols.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarking context on utilization and coverage patterns across major payers, a review of clinical context for epoetin biosimilars in dialysis-associated anemia management, and consideration of policy and coverage factors that influence site-of-service use and billing practices.
This publication provides practical reference material for billing staff, practice managers, and policy analysts: a concise description of the code and service, expected site-of-service settings, common modifiers and operational notes (where available), and guidance on where to find payer-specific coverage criteria. Data not available in the input for payer-specific rates, taxonomies, and ICD-10 code mappings is noted where relevant.
Billing Code Overview
HCPCS Level II code Q5105 describes an injection of epoetin alfa-epbx, biosimilar (Retacrit), dosed per 100 units, indicated for use in patients with end-stage renal disease (ESRD) on dialysis. The service type is therapeutic drug administration delivered by injection.
Typical site of service for this code is dialysis centers or outpatient clinics where patients receive maintenance dialysis and concomitant anemia management. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with end-stage renal disease (ESRD) receiving maintenance hemodialysis in an outpatient dialysis center. The patient has anemia of chronic kidney disease managed with erythropoiesis-stimulating agents. During a routine dialysis encounter, nursing documents hemoglobin trending low and administers an erythropoietin biosimilar dose. The billed service is Q5105 — a 100-unit vial of epoetin alfa-epbx (Retacrit) specifically for patients on dialysis. The clinical workflow includes verification of physician orders, review of most recent hemoglobin and iron studies, medication reconstitution per facility protocol, verification of patient identifiers, administration via subcutaneous or intravenous route during dialysis, documentation of lot number and units administered, and charging the dialysis encounter with the appropriate HCPCS code and any applicable modifier(s). Typical sites of service are outpatient dialysis centers and hospital-based dialysis units. Common patient comorbidities include diabetes mellitus, hypertension, and cardiovascular disease, and monitoring includes serial hemoglobin, transferrin saturation, and ferritin levels to guide dosing adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - standard reporting | Use when no special circumstances apply to the service. |