Summary & Overview
HCPCS Q5130: Pegfilgrastim-pbbk (Fylnetra) 0.5 mg Injection
HCPCS Level II code Q5130 designates an injection of pegfilgrastim-pbbk (Fylnetra), a biosimilar granulocyte colony-stimulating factor supplied in 0.5 mg units. This code captures administration of a biologic used to prevent or treat chemotherapy-induced neutropenia, an important component of supportive oncology care. Nationally, accurate coding of biosimilar injections affects clinical reporting, payer coverage determinations, and drug utilization monitoring.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what Q5130 represents clinically and operationally, common billing modifiers associated with injectable biologics, and expected sites of service where the product is administered. The publication also summarizes benchmark topics readers should expect: reimbursement coding alignment for biosimilars, payer coverage policy considerations, and clinical context for pegfilgrastim biosimilar use.
This piece is designed for billing professionals, oncology clinic administrators, and policy analysts seeking a clear reference on code purpose, payer relevance, and the practical elements that affect billing and care delivery for pegfilgrastim-pbbk injections at the national level.
Billing Code Overview
HCPCS Level II code Q5130 represents an injection of pegfilgrastim-pbbk (Fylnetra), a biosimilar formulation, supplied in 0.5 mg units. The service type is therapeutic biologic injection for neutropenia prophylaxis or treatment related to myelosuppressive chemotherapy, derived from the drug description. The typical site of service is outpatient infusion or clinic-based injection administration, including oncology clinics and ambulatory infusion centers. Data not available in the input.
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|