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.

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HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

Customize your policy alerts

Sign up for hcpcs Q5130 policy alerts

Get alerted when payer policies referencing Q5130 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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 Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed for the professional administration of a subcutaneous injection when payer requires a CPT administration code in addition to the drug HCPCS `Q5130`
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Performed earlier in the visit when the patient receives chemotherapy; `Q5130` administration often occurs on separate day or per protocol following a chemotherapy infusion
`36415`	Collection of venous blood by venipuncture	Performed when laboratory monitoring (CBC) is done before or after pegfilgrastim administration to assess neutrophil response
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Not routinely related but may appear in outpatient oncology visits when counseling services are provided alongside supportive care (use per documentation)
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	Occasionally performed in the same visit if concurrent supportive IV therapy is given; documents supportive infusion services when applicable

Related Modifiers

5 rows

Modifier	Description	When to Use
59	Modifier 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…
53	Modifier 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…
77	Modifier 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]
97	Modifier 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	Specialty	Notes
207Q00000X	Family Medicine Physician	Family 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…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	Nursing Service Providers · Registered Nurse
261QM1000X	Migrant Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QM0850X	Adult Mental Health Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disord…
2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to ob…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C22.0	Liver cell carcinoma
C25.9	Malignant neoplasm of pancreas, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C50.912	Malignant neoplasm of unspecified site of left female breast
C61	Malignant neoplasm of prostate
C71.9	Malignant neoplasm of brain, unspecified
C90.00	Multiple myeloma not having achieved remission
D47.1	Chronic myeloproliferative disease
D61.9	Aplastic anemia, unspecified

Showing 1–10 of 26

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

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly billed for the professional administration of a subcutaneous injection when payer requires a CPT administration code in addition to the drug HCPCS `Q5130`
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Performed earlier in the visit when the patient receives chemotherapy; `Q5130` administration often occurs on separate day or per protocol following a chemotherapy infusion
`36415`	Collection of venous blood by venipuncture	Performed when laboratory monitoring (CBC) is done before or after pegfilgrastim administration to assess neutrophil response
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Not routinely related but may appear in outpatient oncology visits when counseling services are provided alongside supportive care (use per documentation)
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	Occasionally performed in the same visit if concurrent supportive IV therapy is given; documents supportive infusion services when applicable

Related Modifiers

5 rows

Modifier	Description	When to Use
59	Modifier 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…
53	Modifier 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…
77	Modifier 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]
97	Modifier 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	Specialty	Notes
207Q00000X	Family Medicine Physician	Family 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…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	Nursing Service Providers · Registered Nurse
261QM1000X	Migrant Health Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
261QM0850X	Adult Mental Health Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disord…
2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to ob…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C22.0	Liver cell carcinoma
C25.9	Malignant neoplasm of pancreas, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C50.912	Malignant neoplasm of unspecified site of left female breast
C61	Malignant neoplasm of prostate
C71.9	Malignant neoplasm of brain, unspecified
C90.00	Multiple myeloma not having achieved remission
D47.1	Chronic myeloproliferative disease
D61.9	Aplastic anemia, unspecified

Showing 1–10 of 26

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

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

Sign up for hcpcs Q5130 policy alerts

OpenPayer

HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

Sign up for hcpcs Q5130 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

Sign up for hcpcs Q5130 policy alerts

HCPCS Level II Q5130: Pegfilgrastim-pbbk (Fylnetra) Injection, 0.5 mg

Sign up for hcpcs Q5130 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code Q5130 represent?

Which modifiers are commonly associated with billing Q5130 and when are they used?

What related CPT codes might appear on the claim with Q5130?

What is the typical clinical workflow and site of service for administering Q5130?

Which payers are highlighted and why is accurate coding important for Q5130?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code Q5130 represent?

Which modifiers are commonly associated with billing Q5130 and when are they used?

What related CPT codes might appear on the claim with Q5130?

What is the typical clinical workflow and site of service for administering Q5130?

Which payers are highlighted and why is accurate coding important for Q5130?

References