Outpatient Prospective Payment System Part B Drug Payment and Status Indicator Change for Healthcare Common Procedure Coding System Q5122

The following instructions have been provided by CMS to National Government Services for HCPCS code Q5122. For dates of service between 1/1/2021 and 3/31/2021, the status indicator for HCPCS code Q5122 (Injection, pegfilgrastim- apgf, biosimilar, (nyvepria), 0.5 mg) was changed retroactively from status indicator “E2” to status indicator “K.”

This information has been published in CR 12175 and was reflected in the April 2021 I/OCE software.

Below are the updates being made:

• The January 2021 HCPCS file is being updated to include an OPPS payment quarterly rate in January 2021 for Q5122 at $336.896.
• The OPPS 340B payment rate in January 2021 is being corrected for Q5122 at $253.487.
• The co-payment percentage is 20 percent for both the regular OPPS payment rate and the OPPS 340B payment rate.

NGS will adjust impacted  claims when brought to our attention.

 Posted 4/26/2021