Q5122
Q5122 – Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 1 NDC crosswalked per 0.5 MG $136.911/unit ASP+6%
📋 Q5122 summary
Q5122 is a HCPCS Level II Q-code used to bill pegfilgrastim-apgf (nyvepria), 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 Q5122: Nyvepria
Code Q5122
Billing unit 0.5 MG Payment limit $136.911/unit NDC-Crosswalk 1
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 codeQ5122
DescriptorInjection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg
Billing unit0.5 MG
Payment limit / unit$136.911
Est. ASP / unit$129.161 est.
Mapped NDCs1
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
$136.911
Est. ASP / unit
$129.161 est.
Est. after 2% sequester
$134.173
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-apgf (nyvepria), 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 added2021-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of Q5122 = 0.5 mg. 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 Q5122 WITH EST. MEDICARE PAY
1 NDC map to Q5122. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($136.911/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00069-0324-01 | NYVEPRIA pegfilgrastim-apgf 6 mg/.6mL INJECTION, SOLUTION | Pfizer | 1 CARTON in 1 CARTON (0069-0324-01) / 1 S... | 6 mg/.6mL | 12 | $1,642.93 | — | ● 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
$3.1M
Claims
2,011
Beneficiaries
1,030
Spend / beneficiary
$3,008.52
Spend / claim
$1,540.91
Trend by period
Where Q5122 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #287 of 824
#282
PALINGEN OR PALINGEN... Q4173
$3.28M
#283
CAREGRAFT, PER SQ CM... Q4322
$3.22M
#284
PROGRAF(J7507)* J7507
$3.19M
#285
TRILURON J7332
$3.15M
#286
YESCARTA Q2041
$3.13M
#287
NYVEPRIA Q5122
$3.1M
#288
DEPO-MEDROL* J1010
$3.09M
#289
ERIBULIN MESYLATE* J9179
$3.09M
#290
OASIS ULTRA Q4124
$3.07M
#291
THYROGEN J3240
$3.03M
#292
DOXIL* Q2050
$3M
Total claims — #314 of 824
#309
OPTISON Q9956
2,093
#310
DOCIVYX J9172
2,049
#311
GAMMAGARD S-D J1566
2,043
#312
ZEPZELCA J9223
2,021
#313
PALINGEN OR PALINGEN... Q4173
2,012
#314
NYVEPRIA Q5122
2,011
#315
HERCEPTIN HYLECTA J9356
2,001
#316
GLASSIA J0257
1,989
#317
SOLIRIS(J1299) J1299
1,976
#318
HERZUMA Q5113
1,968
#319
EMPLICITI J9176
1,951
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) | $3.1M | 1,030 | 2,011 | $3,008.52 | $1,540.91 |
| 2025 (Q1-Q4) | $13.75M | 2,697 | 9,414 | $5,097.75 | $1,460.44 |
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
$7.1M
Medicare paid
$5.48M
Submitted services
60,241
Denial rate
5.7%
Allowed / service
$125.03
Submitted charges
$41.13M
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 Q5122 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 21,968 services across 15 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.
🗃️ 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
1 NDC 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.
❓ Q5122 billing FAQ
What is HCPCS code Q5122?
Q5122 is a HCPCS Level II Q-code used to bill Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5122?
One unit of Q5122 represents 0.5 MG. Report the number of units equal to the dose administered divided by 0.5 MG.
How many units of Q5122 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 Q5122?
The Medicare Part B payment limit is $136.911 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $134.173 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5122?
1 NDC currently map to Q5122 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 Q5122 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.