Q5105
Q5105 – Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialys · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 13 NDCs crosswalked per 100 UNITS $0.797/unit ASP+6%
📋 Q5105 summary
Q5105 is a HCPCS Level II Q-code used to bill epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units, billed per 100 UNITS. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with Q5105: Retacrit(Q5105), Retacrit
Code Q5105
Billing unit 100 UNITS Payment limit $0.797/unit NDC-Crosswalk 13
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeQ5105
DescriptorInjection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
Billing unit100 UNITS
Payment limit / unit$0.797
Est. ASP / unit$0.752 est.
Mapped NDCs13
Data periodQ3 2026
Last updated2026-08-20
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$0.797
Est. ASP / unit
$0.752 est.
Est. after 2% sequester
$0.781
HCPCS dosage
100 UNITS
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
CoverageD — Special coverage instructions apply
Pricing indicator57
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2020-01-01
Date added2018-07-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of Q5105 = 100 units. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under Q5105 LEAST EXPENSIVE FIRST
13 NDCs map to Q5105. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($0.797/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00069-1305-10 | RETACRIT epoetin alfa-epbx 2000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, SINGLE-DOSE in 1 CARTON (0069-130... | 2000 [iU]/mL | 200 | $159.40 | $22.523 | ● Active | CMS ASP |
| 00069-1308-10 | RETACRIT epoetin alfa-epbx 10000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, SINGLE-DOSE in 1 CARTON (0069-130... | 10000 [iU]/mL | 1,000 | $797.00 | $112.683 | ● Active | CMS ASP |
| 00069-1311-10 | RETACRIT epoetin alfa-epbx 20000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, MULTI-DOSE in 1 CARTON (0069-1311... | 20000 [iU]/mL | 2,000 | $1,594.00 | $224.788 | ● Active | CMS ASP |
| 00069-1309-04 | RETACRIT epoetin alfa-epbx 40000 [iU]/mL INJECTION, SOLUTION | Pfizer | 4 VIAL, SINGLE-DOSE in 1 CARTON (0069-1309... | 40000 [iU]/mL | 1,600 | $1,275.20 | $448.007 | ● Active | CMS ASP |
| 00069-1306-10 | RETACRIT epoetin alfa-epbx 3000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, SINGLE-DOSE in 1 CARTON (0069-130... | 3000 [iU]/mL | 300 | $239.10 | — | ● Active | CMS ASP |
| 00069-1307-10 | RETACRIT epoetin alfa-epbx 4000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, SINGLE-DOSE in 1 CARTON (0069-130... | 4000 [iU]/mL | 400 | $318.80 | — | ● Active | CMS ASP |
| 00069-1318-10 | RETACRIT epoetin alfa-epbx 10000 [iU]/mL INJECTION, SOLUTION | Pfizer | 10 VIAL, MULTI-DOSE in 1 CARTON (0069-1318... | 10000 [iU]/mL | 1,000 | $797.00 | — | ● Active | CMS ASP |
| 59353-0002-10 | RETACRIT epoetin alfa-epbx 2000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, SINGLE-DOSE in 1 CARTON (59353-00... | 2000 [iU]/mL | 200 | $159.40 | — | ● Active | CMS ASP |
| 59353-0003-10 | RETACRIT epoetin alfa-epbx 3000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, SINGLE-DOSE in 1 CARTON (59353-00... | 3000 [iU]/mL | 300 | $239.10 | — | ● Active | CMS ASP |
| 59353-0004-10 | RETACRIT epoetin alfa-epbx 4000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, SINGLE-DOSE in 1 CARTON (59353-00... | 4000 [iU]/mL | 400 | $318.80 | — | ● Active | CMS ASP |
| 59353-0010-10 | RETACRIT epoetin alfa-epbx 10000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, SINGLE-DOSE in 1 CARTON (59353-01... | 10000 [iU]/mL | 1,000 | $797.00 | — | ● Active | CMS ASP |
| 59353-0120-10 | RETACRIT epoetin alfa-epbx 20000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, MULTI-DOSE in 1 CARTON (59353-120... | 20000 [iU]/mL | 2,000 | $1,594.00 | — | ● Active | CMS ASP |
| 59353-0220-10 | RETACRIT epoetin alfa-epbx 10000 [iU]/mL INJECTION, SOLUTION | Vifor | 10 VIAL, MULTI-DOSE in 1 CARTON (59353-220... | 10000 [iU]/mL | 1,000 | $797.00 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$522.38
Claims
13
Beneficiaries
—
Spend / beneficiary
—
Spend / claim
$40.18
Trend by period
Where Q5105 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #784 of 824
#779
METOCLOPRAMIDE HCL J2765
$769.16
#780
BENZTROPINE MESYLATE J0515
$656.40
#781
CIPROFLOXACIN-D5W J0744
$605.35
#782
PROTAMINE SULFATE J2720
$543.58
#783
METOPROLOL TARTRATE J0616
$528.23
#784
RETACRIT(Q5105) Q5105
$522.38
#785
KEPPRA* J1953
$517.51
#786
DAPTOMYCIN(J0873) J0873
$474.41
#787
MEDROL* J7509
$471.06
#788
AFLURIA (90657)* 90657
$440.18
#789
AZITHROMYCIN* J0456
$419.17
Total claims — #815 of 824
#810
CLOFARABINE* J9027
14
#811
ONCASPAR J9266
14
#812
BICILLIN C-R J0558
13
#813
ZINPLAVA J0565
13
#814
PELLOGRAFT, PER SQ C... Q4320
13
#815
RETACRIT(Q5105) Q5105
13
#816
ACETAMINOPHEN(J0134) J0134
12
#817
POSACONAZOLE J1837
12
#818
HYMPAVZI PEN J7172
12
#819
DERMACYTE AMN MEM AL... Q4248
12
#820
ORION, PER SQ CM** Q4276
12
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $522.38 | — | 13 | — | $40.18 |
| 2025 (Q1-Q4) | $480.6K | 1,471 | 3,577 | $326.73 | $134.37 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$5.1K
Medicare paid
$4K
Submitted services
35,871
Denial rate
80.8%
Allowed / service
$0.73
Submitted charges
$82.3K
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
13 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ Q5105 billing FAQ
What is HCPCS code Q5105?
Q5105 is a HCPCS Level II Q-code used to bill Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5105?
One unit of Q5105 represents 100 UNITS. Report the number of units equal to the dose administered divided by 100 UNITS.
How many units of Q5105 should I bill?
Divide the dose administered by the code's unit size (100 UNITS) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for Q5105?
The Medicare Part B payment limit is $0.797 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $0.781 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5105?
13 NDCs currently map to Q5105 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean Q5105 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.