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    v1.0.30
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5130-pegfilgrastim-pbbk-fylnetra-0-5-mg-injection
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    HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

    HCPCS Level II code Q5130 describes the injection of pegfilgrastim-pbbk (Fylnetra) 0.5 mg, a biosimilar neutrophil-stimulating agent used to reduce the duration of chemotherapy-induced neutropenia; the service is an injectable biologic/oncology support medication typically administered in outpatient infusion centers, oncology clinics, or physician offices as an administered drug service.

    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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    Clinical & Coding Specifications

    Clinical Context

    A typical patient receiving Q5130 is an adult oncology patient undergoing myelosuppressive chemotherapy with a high risk of febrile neutropenia. The patient presents to an outpatient oncology infusion clinic or an ambulatory care center on the day after chemotherapy or per institutional protocol for administration of the pegfilgrastim biosimilar fylnetra (pegfilgrastim-pbbk) as a single subcutaneous injection. The clinical workflow includes verification of patient identity and chemotherapy cycle, review of recent complete blood count and symptoms, obtaining informed consent for the supportive growth factor, preparing the appropriate dose based on the product strength (0.5 mg unit concentration; multiple units may be required to reach the prescribed dose), medication reconciliation (checking for prior G-CSF use, allergies), administration (subcutaneous injection), observation for immediate adverse reactions (typically 15–30 minutes), documentation of lot number and expiration, and billing using Q5130 with any applicable modifier for payer routing and medical necessity documentation. Typical sites of service are outpatient infusion center, physician office, or ambulatory clinic; in some cases, home health or specialty pharmacy–coordinated administration occurs using the appropriate modifiers and documentation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularCommonly billed for the professional administration of a subcutaneous injection when payer requires a CPT administration code in addition to the drug HCPCS Q5130
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugPerformed earlier in the visit when the patient receives chemotherapy; Q5130 administration often occurs on separate day or per protocol following a chemotherapy infusion
    36415Collection of venous blood by venipuncturePerformed when laboratory monitoring (CBC) is done before or after pegfilgrastim administration to assess neutrophil response
    99406Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutesNot routinely related but may appear in outpatient oncology visits when counseling services are provided alongside supportive care (use per documentation)
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourOccasionally performed in the same visit if concurrent supportive IV therapy is given; documents supportive infusion services when applicable

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    [object Object]
    97Modifier 97 is an informational modifier used with therapy CPT codes to indicate services are rehabilitative — intended to restore skills or function lost due to illness, injury, or disability. It is…- Use modifier 97 when reporting therapy services that are rehabilitative in nature — i.e., provided to restore skills or function lost or impaired because of illness, injury, or disability (for…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207R00000X
    363A00000X
    364S00000X
    163WP0809X
    261QM1000X
    261QM0850X
    2084A0401X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C22.0Liver cell carcinoma
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.912Malignant neoplasm of unspecified site of left female breast
    C61Malignant neoplasm of prostate
    C71.9Malignant neoplasm of brain, unspecified
    C90.00Multiple myeloma not having achieved remission
    D47.1Chronic myeloproliferative disease
    D61.9Aplastic anemia, unspecified

    Showing 1–10 of 26

    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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