Summary & Overview
HCPCS Q5127: Pegfilgrastim-fpgk (Stimufend) 0.5 mg Injection
HCPCS Level II code Q5127 designates the 0.5 mg injection of pegfilgrastim-fpgk (brand name Stimufend), a biosimilar granulocyte colony-stimulating factor used to reduce the incidence of infection in patients receiving myelosuppressive chemotherapy. This code matters nationally as biosimilar biologics expand therapeutic options and affect coverage, utilization, and cost management across payers.
Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for pegfilgrastim biosimilars, typical sites of service where Q5127 is billed, and payer coverage landscapes. The publication summarizes benchmarks for utilization and financial impacts where available, recent policy considerations around biosimilar substitution and billing, and coding clarifications relevant to administration of pegfilgrastim biosimilars.
The report is intended for revenue cycle managers, oncology clinicians, and policy analysts seeking a national-level reference on coding, clinical context, and payer patterns for biosimilar pegfilgrastim represented by HCPCS Level II code Q5127.
Billing Code Overview
HCPCS Level II code Q5127 represents the injection formulation pegfilgrastim-fpgk (Stimufend), a biosimilar product dosed at 0.5 mg. This code is used to report administration of the specified biosimilar pegfilgrastim preparation for indications consistent with granulocyte colony-stimulating factor therapy.
Service type: Injection administration of a biosimilar biologic
Typical site of service: Outpatient infusion clinic, oncology clinic, or physician office
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with stage IIIB non-small cell lung cancer receives myelosuppressive chemotherapy and requires prophylaxis against chemotherapy-induced neutropenia. The oncology clinic schedules same-day administration of a single subcutaneous dose of pegfilgrastim biosimilar Q5127 (pegfilgrastim-fpgk, Stimufend) 6 mg (reported per 0.5 mg unit of the HCPCS descriptor as appropriate) following completion of chemotherapy. The clinical workflow includes verification of chemotherapy completion, assessment of current blood counts and symptoms, patient consent, preparation of the biosimilar injection by an authorized clinician or qualified nursing staff, administration via subcutaneous injection in the clinic or as a take-home prefilled syringe when permitted by payer policy, documentation of lot number and expiration, and billing using Q5127 with applicable modifier for administration circumstances. Typical sites of service include outpatient oncology infusion centers, physician offices, hospital outpatient departments, and occasionally home health settings when permitted by policy. The common clinical goal is to reduce duration of neutropenia and the risk of febrile neutropenia, enabling adherence to planned chemotherapy dosing and schedule.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier |