HCPCS Code Details - Q5105

HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q5105
Description

Long description:
Injection, epoetin alfa, biosimilar, (retacrit) (for esrd on dialysis), 100 units

Short description:
Inj retacrit esrd on dialysi

HCPCS Modifier1
HCPCS Pricing indicator 57 - Other carrier priced
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Jul 01, 2018 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1E - Other drugs
HCPCS Action code A - Add procedure or modifier code
Type of service 1 - Medical care
Effective date Effective Jul 01, 2018
Date added Added Jul 01, 2018
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - Q5105

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
April 1, 2019 - June 30, 2019 100 UNITS 1.13609 - - - - - -
January 1, 2019 - March 31, 2019 100 UNITS 1.13609 - - - - - -
October 1, 2018 - December 31, 2018 100 UNITS 1.16918 - - - - - -
July 1, 2018 - September 30, 2018 100 UNITS 1.16918 - - - - - -

See also

  • HCPCS Q5104 · Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

  • HCPCS J0885 · Injection, epoetin alfa, (for non-esrd use), 1000 units

  • HCPCS J0886 · Injection, epoetin alfa, 1000 units (for esrd on dialysis)

  • HCPCS Q4081 · Injection, epoetin alfa, 100 units (for esrd on dialysis)

  • HCPCS Q5106 · Injection, epoetin alfa, biosimilar, (retacrit) (for non-esrd use), 1000 units


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”