Q5106
Q5106 – Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 19 NDCs crosswalked per 1000 UNITS $7.968/unit ASP+6%
📋 Q5106 summary
Q5106 is a HCPCS Level II Q-code used to bill epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units, billed per 1000 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 Q5106: Retacrit(Q5106), Retacrit
Code Q5106
Billing unit 1000 UNITS Payment limit $7.968/unit NDC-Crosswalk 19
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 codeQ5106
DescriptorInjection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Billing unit1000 UNITS
Payment limit / unit$7.968
Est. ASP / unit$7.517 est.
Mapped NDCs19
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
$7.968
Est. ASP / unit
$7.517 est.
Est. after 2% sequester
$7.809
HCPCS dosage
1000 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 non-esrd use), 1000 units
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service9 — Other medical items or services
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 Q5106 = 1,000 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 Q5106 LEAST EXPENSIVE FIRST
19 NDCs map to Q5106. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($7.968/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 | 20 | $159.36 | $22.523 | ● Active | CMS + PDAC |
| 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 | 100 | $796.80 | $112.683 | ● Active | CMS + PDAC |
| 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 | 200 | $1,593.60 | $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 | 160 | $1,274.88 | $448.007 | ● Active | CMS + PDAC |
| 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 | 30 | $239.04 | — | ● Active | CMS + PDAC |
| 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 | 40 | $318.72 | — | ● Active | CMS + PDAC |
| 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 | 100 | $796.80 | — | ● Active | CMS + PDAC |
| 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 | 20 | $159.36 | — | ● Active | CMS + PDAC |
| 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 | 30 | $239.04 | — | ● Active | CMS + PDAC |
| 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 | 40 | $318.72 | — | ● Active | CMS + PDAC |
| 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 | 100 | $796.80 | — | ● Active | CMS + PDAC |
| 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 | 200 | $1,593.60 | — | ● 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 | 100 | $796.80 | — | ● Active | CMS + PDAC |
| 59353-0220-01 | RETACRIT 10000 U/1 ML | Unknown | — | — | 10 | $79.68 | — | — | PDAC |
| 59353-0010-01 | RETACRIT (PF) 10000 U/1 ML | Unknown | — | — | 10 | $79.68 | — | — | PDAC |
| 59353-0004-01 | RETACRIT (PF) 4000 U/1 ML | Unknown | — | — | 4 | $31.87 | — | — | PDAC |
| 59353-0003-01 | RETACRIT (PF) 3000 U/1 ML | Unknown | — | — | 3 | $23.90 | — | — | PDAC |
| 59353-0002-01 | RETACRIT (PF) 2000 U/1 ML | Unknown | — | — | 2 | $15.94 | — | — | PDAC |
| 00069-1309-10 | RETACRIT (PF) 40000 U/1 ML | Unknown | — | — | 40 | $318.72 | — | — | PDAC |
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
$8.68M
Claims
33,752
Beneficiaries
11,921
Spend / beneficiary
$727.85
Spend / claim
$257.07
Trend by period
Where Q5106 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #192 of 824
#187
ADVATE* J7192
$9.33M
#188
EVKEEZA J1305
$9.25M
#189
SYNVISC-ONE* J7325
$8.99M
#190
EPOGEN(J0885)* J0885
$8.75M
#191
EUFLEXXA J7323
$8.7M
#192
RETACRIT(Q5106) Q5106
$8.68M
#193
QUTENZA J7336
$8.51M
#194
DEXTENZA J1096
$8.47M
#195
XOFIGO A9606
$8.42M
#196
TYENNE AUTOINJECTOR* Q5135
$8.37M
#197
TNKASE J3101
$8.36M
Total claims — #75 of 824
#70
YUPELRI J7677
37,078
#71
ACTEMRA(J3262) J3262
36,246
#72
JUBBONTI* Q5136
34,987
#73
ENVARSUS XR J7503
34,358
#74
RECLAST* J3489
34,241
#75
RETACRIT(Q5106) Q5106
33,752
#76
LEVULAN J7308
31,923
#77
FERAHEME(Q0138)* Q0138
31,621
#78
EPOGEN(J0885)* J0885
31,448
#79
PRIVIGEN J1459
30,530
#80
FORMOTEROL FUMARATE* J7606
29,560
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) | $8.68M | 11,921 | 33,752 | $727.85 | $257.07 |
| 2025 (Q1-Q4) | $39.66M | 25,107 | 154,396 | $1,579.55 | $256.86 |
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
$15.95M
Medicare paid
$11.99M
Submitted services
2,476,810
Denial rate
13.5%
Allowed / service
$7.44
Submitted charges
$62.48M
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.
🗺️ Where Q5106 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 1,562,860 services across 40 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
📊 What bills under Q5106
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ 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 + DMEPDAC (PDAC)
19 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.
❓ Q5106 billing FAQ
What is HCPCS code Q5106?
Q5106 is a HCPCS Level II Q-code used to bill Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5106?
One unit of Q5106 represents 1000 UNITS. Report the number of units equal to the dose administered divided by 1000 UNITS.
How many units of Q5106 should I bill?
Divide the dose administered by the code's unit size (1000 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 Q5106?
The Medicare Part B payment limit is $7.968 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $7.809 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5106?
19 NDCs currently map to Q5106 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 Q5106 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.