Q5120 NDC Crosswalk, Billing Units, ASP Payment & Medicare Reimbursement

📋 Q5120 summary

Q5120 is a HCPCS Level II Q-code used to bill pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg, billed per 0.5 MG. 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 Q5120: Ziextenzo

Code Q5120 Billing unit 0.5 MG Payment limit $132.096/unit NDC-Crosswalk 2 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 codeQ5120

DescriptorInjection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg

Billing unit0.5 MG

Payment limit / unit$132.096

Est. ASP / unit$124.619 est.

Mapped NDCs2

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

$132.096

Est. ASP / unit

$124.619 est.

Est. after 2% sequester

$129.454

HCPCS dosage

0.5 MG

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, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg

CoverageC — Carrier/MAC judgment

Pricing indicator51 — Drug — priced under the ASP methodology

Type of service1 — Medical care

BETOS-2O1E

ASC payment groupYY

Action codeN — No maintenance this year

Effective date2023-04-01

Date added2020-07-01

Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of Q5120 = 0.5 mg. Enter a regimen to convert dose → billing units and project a full course.

Dose per administration (mg) Frequency — every days Number of doses NDC / package billed (optional)

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 Q5120 WITH EST. MEDICARE PAY

2 NDCs map to Q5120. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($132.096/unit) × that package's bill units.

NDC (11-digit)	Drug	Labeler	Package	Strength	Bill units	Est. pay / pkg	NADAC / unit	Status	Source
61314-0866-01	Ziextenzo	Sandoz	—	—	12	$1,585.15	—	—	CMS ASP
61314-0866-02	ZIEXTENZO pegfilgrastim-bmez 6 mg/.6mL INJECTION	Sandoz	1 BLISTER PACK in 1 CARTON (61314-866-02)...	6 mg/.6mL	12	$1,585.15	—	● 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.

⚠️ Don't confuse Q5120 with… RELATED CODES

Adjacent HCPCS codes that share an ingredient or formulation with Q5120. Billing units and payment limits differ — confirm the exact code, strength and form before billing.

Code	Descriptor	Billing unit	Payment limit / unit	How it differs from Q5120
Q5111	Injection, udenyca 0.5 mg	0.5 MG	$149.133	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
Q5108	Injection, fulphila	0.5 MG	$67.024	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
Q5127	Inj, stimufend, 0.5 mg	0.5 MG	$143.673	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J2506	Inj pegfilgrast ex bio 0.5mg	0.5 MG	$143.233	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
Q5130	Inj, fylnetra, 0.5 mg	0.5 MG	$105.109	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
Q5122	Inj, nyvepria	0.5 MG	$136.911	Related ingredient or formulation — confirm strength, form and billing unit before substituting.

Related codes matched on shared ingredient (CMS Medicare Part B Spending feed). Billing units and payment limits from the CMS ASP Pricing File. Always verify the precise HCPCS code for the product and strength administered.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Period

Total Part B spend

$35.2K

Claims

29

Beneficiaries

13

Spend / beneficiary

$2,708.91

Spend / claim

$1,214.34

Trend by period

Where Q5120 ranks among Part B drugs · 2026 (Q1) · neighbors ±5

Total spending — #623 of 824

#618 FAMOTIDINE J1308 $37.8K #619 ZINPLAVA J0565 $36.7K #620 ESANO ACA, PER SQ CM... Q4275 $36.1K #621 DERMACYTE AMN MEM AL... Q4248 $35.9K #622 ONDANSETRON HCL(J240... J2405 $35.4K #623 ZIEXTENZO Q5120 $35.2K #624 ALKERAN* J9245 $35.1K #625 GANCICLOVIR SODIUM J1570 $34.8K #626 BYOOVIZ Q5124 $34.5K #627 DEPO-ESTRADIOL J1000 $33.6K #628 SURGRAFT FT PER SQ C... Q4268 $33.2K

Total claims — #746 of 824

#741 LEVOTHYROXINE SODIUM... J0650 30 #742 TEMODAR J9328 30 #743 CYGNUS, PER SQ CM** Q4170 30 #744 BRIXADI(J0577) J0577 29 #745 HYPERRHO* J2790 29 #746 ZIEXTENZO Q5120 29 #747 HYPERHEP B* 90371 28 #748 SPEVIGO J1747 28 #749 TIGECYCLINE* J3243 28 #750 VFEND IV* J3465 28 #751 VALRUBICIN* J9357 28

Full breakdown by period (2)

Period	Total spend	Beneficiaries	Claims	$/beneficiary	$/claim
2026 (Q1)	$35.2K	13	29	$2,708.91	$1,214.34
2025 (Q1-Q4)	$53K	75	160	$706.70	$331.27

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

$9K

Medicare paid

$6.9K

Submitted services

744

Denial rate

22.6%

Allowed / service

$15.60

Submitted charges

$256.5K

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

2 NDCs mapped

NADAC acquisition cost

CMS National Average Drug Acquisition Cost (weekly)

Not 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.

❓ Q5120 billing FAQ

What is HCPCS code Q5120?

Q5120 is a HCPCS Level II Q-code used to bill Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg under Medicare Part B and most medical (not pharmacy) benefits.

What is the billing unit for Q5120?

One unit of Q5120 represents 0.5 MG. Report the number of units equal to the dose administered divided by 0.5 MG.

How many units of Q5120 should I bill?

Divide the dose administered by the code's unit size (0.5 MG) 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 Q5120?

The Medicare Part B payment limit is $132.096 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $129.454 per unit. Payment limits are revised quarterly.

Which NDCs bill under Q5120?

2 NDCs currently map to Q5120 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 Q5120 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.

Q5120 – Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg · NDC Crosswalk & Billing Units