Does Q5111 require prior authorization?

Yes, Q5111 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for Q5111?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Backwork Sign up free

`Q5111`, Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When Neulasta® or UDENYCA® is administered by prefilled syringe, report the drug HCPCS code (J2506 or Q5111) and the administration CPT code 96372 in the medical record/claim.
When Neulasta® or UDENYCA® is administered via an on-body injector (Neulasta® Onpro® or UDENYCA® ONBODY™), document and identify use of the on-body injector in the medical record and report CPT code 96377 (application of on-body injector).

Key Coverage Criteria

Pegfilgrastim (Neulasta® or UDENYCA®) is covered to decrease the incidence of infection manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim (J2506) is indicated to decrease the incidence of infection manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim may be administered via prefilled syringe or via an on-body injector (e.g., Neulasta Onpro or UDENYCA ONBODY) as approved delivery methods.
Same‑day administration (on the day of chemotherapy) may be allowed when patient or caregiver circumstances create a significant barrier to returning for next‑day dosing (for example, lack of transportation).
Medically necessary use of Leukine, Neupogen, Nivestym, Nypozi, Releuko, and Zarxio for bone marrow/stem cell transplant indications when: (a) non-myeloid malignancies with myeloablative chemotherapy followed by BMT; or (b) mobilization of hematopoietic progenitor cells into peripheral blood for leukapheresis; or (c) PSCT after myeloablative chemotherapy.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.

17 Active Policies

PALMETTO-JJ-L37176, White Cell Colony Stimulating Factors

PALMETTO-JM-L37176, White Cell Colony Stimulating Factors

BCBSNJ-DRUGS-012-E7C32F18C6, Granulocyte Colony Stimulating Factor (G-CSF - Neupogen, Neulasta, Granix, Zarxio, Fulphila, Nivestym, Udenyca, Ziextenzo, Nyvepria) and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF - Leukine)

MODA-PEGFILGRASTIM-894B6C2794, Long-Acting Granulocyte Colony Stimulating Factors (LA-GCSF): Fulphila; Fylnetra; Neulasta; Nyvepria; Pegfilgrastimfpgk; Rolvedon; Ryzneuta; Stimufend; Udenyca; Ziextenzo

A56748, Billing and Coding: White Cell Colony Stimulating Factors

A59126, Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506

UHC-POL-white-blood-cell-colony-stimulating-factors, White Blood Cell Colony Stimulating Factors

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX502.061, Oncology Medications

UMR-POL-UMR-white-blood-cell-colony-stimulating-factors, White Blood Cell Colony Stimulating Factors

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

SUREST-POL-SUREST-white-blood-cell-colony-stimulating-factors, White Blood Cell Colony Stimulating Factors

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

BCBSTN-19ec4a9011, Pegfilgrastim (Neulasta); Pegfilgrastim-jmdb (Fulphila); Pegfilgrastim--pbbk (Fylnetra); Pegfilgrastim- apgf (Nyvepria); Pegfilgrastim-fpgk (Stimufed); Pegfilgrastim-cbqv (Udenyca); Pegfilgrastim-bmez (Ziextenzo)

A54682, Billing and Coding: Neulasta (pegfilgrastim) Onpro Kit / UDENYCA ONBODY (On-body Injector)

`Q5111`, Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

Have a follow-up question?

Q5111, Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

17 Active Policies

Related Codes

Have a follow-up question?

`Q5111`, Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg