HCPCS Q5149: Aflibercept-abzv (Enzeevu) Injection, 1 mg

HCPCS Level II code Q5149 designates a 1 mg dose of aflibercept-abzv (Enzeevu), a biosimilar anti-VEGF agent administered by injection. This code is relevant for ophthalmology practices, ambulatory surgical centers, and payers managing specialty drug coverage for retinal disease therapies. Nationally, biosimilar entries like Q5149 influence formulary decisions, utilization patterns, and cost-management strategies for retinal vascular conditions treated with intravitreal anti-VEGF injections.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the typical clinical setting, and which major payers are included in the analysis. The publication covers billing benchmarks, reimbursement considerations, and clinical context for intravitreal biosimilar aflibercept, plus practical notes on service delivery sites and coding nomenclature. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, and payer-specific reimbursement rates are identified as unavailable.

This summary equips billing professionals, practice administrators, and policy analysts with a clear, national-level understanding of HCPCS Level II code Q5149 and its role in ophthalmic biosimilar therapy coding and coverage.

Billing Code Overview

HCPCS Level II code Q5149 denotes injection, aflibercept-abzv (Enzeevu), biosimilar, 1 mg. This code covers administration of a biosimilar formulation of aflibercept intended for intravitreal use in ophthalmology.

Service type: Intravitreal injection of a biosimilar anti-VEGF agent

Typical site of service: Outpatient ophthalmology clinic or ambulatory surgery center

Clinical Context

A 72-year-old patient with neovascular (wet) age-related macular degeneration presents to an ophthalmology clinic for intravitreal pharmacologic therapy. The treating retinal specialist documents diminished central vision and active subretinal fluid on optical coherence tomography consistent with choroidal neovascularization. After informed consent, the patient is prepped in a procedure room or ambulatory surgical center; topical anesthetic and antiseptic are applied, and a single intravitreal injection of Q5149 (injection, aflibercept-abzv [enzeevu], biosimilar, 1 mg) is administered into the vitreous cavity under sterile technique. Post-injection, intraocular pressure is checked, and the patient receives post-procedure instructions and follow-up scheduling. Typical sites of service include an ophthalmology office procedure room, ambulatory surgical center, or hospital outpatient department. The typical patient scenario includes ongoing treatment of retinal vascular disorders such as neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion where anti-VEGF therapy with aflibercept biosimilar is clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to provide the injection is substantially greater than typical (e.g., complex ocular anatomy, extensive additional procedures during same visit).

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Retinal specialists and general ophthalmologists who administer intravitreal injections.
`207WP2900X`	Vitreoretinal Surgery	Subspecialists performing complex retinal procedures and intravitreal therapies.
`363L00000X`	Ambulatory Care Facility	Facilities where outpatient injections commonly occur (procedure rooms, ambulatory surgical centers).
`208D00000X`	Optometry	In some regions, optometrists with appropriate scope may assist or co-manage follow-up care.
`364SF0100X`	Certified Registered Nurse Anesthetist (CRNA)	In rare cases where anesthesia is required for a procedure visit.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H35.32`	Exudative age-related macular degeneration	Primary indication for intravitreal anti-VEGF therapy including aflibercept biosimilar.
`H36.0`	Diabetic retinopathy	May be associated with diabetic macular edema treated with intravitreal anti-VEGF agents.
`H35.81`	Retinal edema	Macular or cystoid edema often treated with intravitreal anti-VEGF injections.
`H34.8`	Other retinal vascular occlusions	Includes retinal vein occlusion where intravitreal anti-VEGF therapy is commonly used for associated macular edema.
`H35.89`	Other specified retinal disorders	Used for retinal conditions responsive to pharmacologic intravitreal therapy when a more specific code is not available.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67028`	Intravitreal injection of a pharmacologic agent (separate procedure)	Billed for the intravitreal injection procedure when a physician or qualified provider administers the anti-VEGF agent; commonly performed with `Q5149` supply/drug billing.
`67042`	Treatment of retinal detachment; pneumatic retinopexy (external)	Not typically performed with routine injections but may be relevant when retinal complications arise and require additional retinal procedures.
`92250`	Fundus photography with interpretation and report	Performed before or after injection to document retinal appearance and treatment response.
`92134`	Scanning computerized ocular diagnostic imaging, posterior segment, with interpretation and report; OCT macula	Performed before injection to document macular fluid and guide treatment need and during follow-up to monitor therapeutic effect.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Commonly billed for pre-injection evaluation or routine follow-up visits in the clinical workflow.

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Summary & Overview