Summary & Overview
HCPCS Q5111: Pegfilgrastim-cbqv (Udenyca) Injection, 0.5 mg
HCPCS Level II code Q5111 designates administration of pegfilgrastim-cbqv (Udenyca), a 0.5 mg biosimilar of pegfilgrastim used to reduce febrile neutropenia risk in patients undergoing myelosuppressive chemotherapy. Nationally, this code matters because biosimilar granulocyte colony-stimulating factors are increasingly used to manage chemotherapy-induced neutropenia, affecting pharmacy and outpatient infusion billing, payer coverage policies, and oncology practice workflows. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents clinically, the typical service setting for administration, and which major payers are relevant for coverage considerations. The publication summarizes common billing practices, typical sites of service, and the clinical context for pegfilgrastim biosimilar injections. Data not available in the input for payer-specific rates, taxonomies, ICD-10 pairings, and related codes will be noted separately. This overview provides a concise reference for billing staff, oncology clinicians, and policy analysts working with biosimilar supportive-care agents in outpatient settings.
Billing Code Overview
HCPCS Level II code Q5111 represents an injection of pegfilgrastim-cbqv (Udenyca), biosimilar, 0.5 mg. This code is used for billing administration of a biosimilar granulocyte colony-stimulating factor product intended to reduce the incidence of infection in patients receiving myelosuppressive chemotherapy.
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Service type: Prescription biologic injection
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Typical site of service: Outpatient infusion clinic or physician office
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving myelosuppressive chemotherapy for non-myeloid malignancy (for example, stage II–III breast cancer or lymphoma) who is at high risk for febrile neutropenia. The patient presents to an oncology clinic or ambulatory infusion center for supportive care. The clinician orders a single subcutaneous injection of the pegfilgrastim biosimilar Q5111 (pegfilgrastim-cbqv, Udenyca) 0.5 mg vial or syringe equivalent on the day after chemotherapy or as per institution protocol. Nursing verifies the chemotherapy regimen, documents the most recent absolute neutrophil count, reviews allergies and prior reactions to granulocyte-colony stimulating factors, obtains informed consent for supportive therapy, prepares the dose using aseptic technique, and administers the subcutaneous injection in the clinic or infusion center. Post-injection monitoring for immediate adverse reactions lasts briefly in the clinic; patient education is provided on expected side effects (bone pain, injection-site reactions) and instructions for fever or signs of infection. Typical sites of service are an outpatient oncology clinic, ambulatory infusion center, or physician office with chemotherapy services; administration may also occur in a hospital outpatient department for patients receiving concurrent inpatient services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified (default) |