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    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5106-epoetin-alfa-epbx-retacrit-1000-units-injection
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    HCPCS Q5106: Injection, epoetin alfa-epbx (Retacrit), 1000 units

    HCPCS Level II code Q5106 describes administration of injection of epoetin alfa-epbx (Retacrit), a biosimilar erythropoiesis-stimulating agent for non-end-stage renal disease (non-ESRD) indications, specified as 1000 units; the service is a drug injection typically provided in outpatient infusion clinics, physician offices, or other ambulatory care settings where parenteral biologic therapies are administered.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old female with chemotherapy-induced anemia secondary to metastatic breast cancer presents to the oncology infusion center for outpatient management of symptomatic anemia. Her hemoglobin is 8.6 g/dL and the oncology team elects to administer an erythropoiesis-stimulating agent to reduce transfusion needs and improve quality of life. The service provided is Q5106 — injection of epoetin alfa-epbx (Retacrit) 1000 units — administered subcutaneously in the clinic. The clinical workflow includes order entry by the oncologist, pharmacist verification of dose and formulary/biosimilar selection, nursing preparation and counseling, administration with documentation of lot number and expiration, observation for immediate adverse events, and billing to the patient’s medical benefit using appropriate modifiers and diagnosis linkage for chemotherapy-induced anemia (or other approved non-ESRD indications). Typical site of service is an outpatient infusion center, oncology clinic, or physician office that manages supportive oncology therapies. Supplies, injection administration, and patient education are documented in the medical record per payer requirements.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularCommonly billed for the act of administering Q5106 when the payer requires a separate administration code in addition to the drug HCPCS.
    90772Therapeutic, prophylactic, or diagnostic injection administration with monitoring for adverse effects; subcutaneous or intramuscular (add-on)Used by some practices to report additional monitoring time or when payer policy supports separate administration codes with monitoring.
    36415Collection of venous blood by venipuncturePerformed before or during the visit to obtain hemoglobin and laboratory monitoring needed to authorize ESA dosing.
    99070Supplies and materials (except spectacles), non-covered items or services, used during the visitMay be used to bill for non-bundled supplies if payer allows separate reporting.
    96365Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hourRelevant when epoetin therapy is provided as part of a longer infusion-based visit or when IV access and infusion services are part of the encounter.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    111NN0400XNeurology ChiropractorChiropractic Neurology is defined as the field of functional neurology that engages the internal - and external environment of the individual in a str…
    103G00000XClinical NeuropsychologistA clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to norma…
    2084N0402XNeurology with Special Qualifications in Child Neurology PhysicianA Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, e…

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    C44.90Unspecified malignant neoplasm of skin, unspecified
    C50.912Malignant neoplasm of unspecified site of left female breast
    C61Malignant neoplasm of prostate
    C81.90Hodgkin lymphoma, unspecified, unspecified site
    C82.90Follicular lymphoma, unspecified, unspecified site
    C83.90Non-follicular (diffuse) lymphoma, unspecified, unspecified site
    C90.00Multiple myeloma not having achieved remission
    C91.10Chronic lymphocytic leukemia of B-cell type not having achieved remission
    D46.9Myelodysplastic syndrome, unspecified
    D47.9Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV)blue cross blue shield - louisiana2026-09-15

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

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

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

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

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

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

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

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    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 Infusion Plus Other Technique(s), Per Visit

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

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 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. 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. 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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