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    HCPCS Details

    HCPC Q5105
    Short Description Inj retacrit esrd on dialysi
    Long Description Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
    Pricing indicator 57
    Coverage code D
    ASC payment group code YY
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2020-01-01
    Date Added 2018-07-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00069130510 Q5105 Inj retacrit esrd on dialysi RETACRIT PFIZER INC. 100 UNITS 1 10 20 200
    00069130610 Q5105 Inj retacrit esrd on dialysi RETACRIT PFIZER INC. 100 UNITS 1 10 30 300
    00069130710 Q5105 Inj retacrit esrd on dialysi RETACRIT PFIZER INC. 100 UNITS 1 10 40 400
    00069130810 Q5105 Inj retacrit esrd on dialysi RETACRIT PFIZER INC. 100 UNITS 1 10 100 1000
    00069130904 Q5105 Inj retacrit esrd on dialysi RETACRIT PFIZER INC. 100 UNITS 1 4 400 1600
    00069131110 Q5105 Inj retacrit esrd on dialysi Retacrit PFIZER INC. 100 UNITS 1 10 200 2000
    00069131810 Q5105 Inj retacrit esrd on dialysi Retacrit PFIZER INC. 100 UNITS 2 10 100 1000
    59353000210 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 1 10 20 200
    59353000310 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 1 10 30 300
    59353000410 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 1 10 40 400
    59353001010 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 1 10 100 1000
    59353012010 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 1 10 200 2000
    59353022010 Q5105 Inj retacrit esrd on dialysi Retacrit VIFOR (INTERNATIONAL) LTD. 100 UNITS 2 10 100 1000
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 100 UNITS
    HCPCS/CPT Billing Units 0.01
    Total doses ordered
    Billing Units 0.01