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    v1.0.30
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5128-ranibizumab-eqrn-cimerli-intravitreal-injection-0-1-mg
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    HCPCS Level II Q5128: Ranibizumab-eqrn (Cimerli) 0.1 mg Injection

    HCPCS Level II code Q5128 represents injection of ranibizumab-eqrn (Cimerli), a ranibizumab biosimilar, dosed at 0.1 mg; this is an intravitreal ophthalmic medication administration typically delivered as an outpatient specialty drug injection in an ophthalmology clinic or ambulatory surgery center for treatment of retinal disease.

    For related coverage guidance, see recent payer policy updates: Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatment, HIV/AIDS Pharmacologic Prevention and Treatment, Long-Acting Injectable Antiretroviral Agents for HIV.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old patient with neovascular (wet) age-related macular degeneration presents to the ophthalmology clinic with decreased central vision and new subretinal fluid on optical coherence tomography. The retina specialist assesses visual acuity, performs a slit-lamp and dilated fundus exam, and documents the need for an intravitreal anti-VEGF injection. The medication selected is the ranibizumab biosimilar Q5128 (ranibizumab-eqrn, cimerli) dosed per product labeling as an intravitreal injection of 0.1 mg. The clinic verifies informed consent, reviews allergy history, confirms laterality, and performs topical anesthesia and povidone-iodine prep. A sterile field is established in a procedure room within the ambulatory surgical center or office-based ophthalmology suite. After injection, the provider monitors the patient for immediate adverse events, documents the procedure including drug, dose, lot number, and laterality, and provides post-procedure instructions. Follow-up visits include IOP check and retinal imaging to guide further injections.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    67028Intravitreal injection of a pharmacologic agent (separate procedure)Primary procedure code for the intravitreal delivery of anti-VEGF agents; used when billing the injection-related professional service alongside the drug HCPCS code Q5128.
    92250Fundus photography with interpretation and reportOften performed before or after injection to document retinal anatomy and response to therapy.
    92134Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report; optical coherence tomography (OCT)Commonly used for treatment decision-making and monitoring response to intravitreal ranibizumab injections.
    99212Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutesCommon for brief follow-up or medication administration visits related to injection care; select level based on complexity.
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesFrequently reported for pre-injection assessment and documentation when moderate complexity evaluation is performed.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…
    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…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207W00000X
    2084P0800X
    363L00000X
    3336L0003X
    246ZA2600X
    251C00000X
    1223D0001X
    2080P0205X

    Related ICD-10-CM Codes

    17 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B30.9Viral conjunctivitis, unspecified
    E03.9Hypothyroidism, unspecified
    E11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
    H10.9Unspecified conjunctivitis
    H11.10Unspecified conjunctival degenerations
    H35.351Cystoid macular degeneration, right eye
    H35.352Cystoid macular degeneration, left eye
    H35.353Cystoid macular degeneration, bilateral
    H40.9Unspecified glaucoma

    Showing 1–10 of 17

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    HIV/AIDS Pharmacologic Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    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 Vector-Borne InfectionsOscar Health2026-10-01

    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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