Q5105 HCPCS - INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR ESRD ON DIALYSIS), 100 UNITS

Code Information

  • HCPCS Code: Q5105
  • Sequence Number: 0010
  • Short Description: Inj retacrit esrd on dialysi
  • Long Description: Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
  • Date Added: 7/1/2018
  • Action Code: N - No maintenance for this code
  • Action Effective Date: 1/1/2020
  • Classification: Temporary Codes
  • Coding System: HCPCS

Code Type

  • Berenson-Eggers Type Of Service Code: O1E - Other drugs
  • Type Of Service Code:
    • 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
    • L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)

Billing Information

  • Pricing Indicator Code:
    • 57 - Other carrier priced
  • Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
  • Coverage Issues Manual Reference Section Number:
      N/A
    • Medicare Carriers Manual Reference Section Number:
      • 4273.1
    • Coverage Code: D - Special coverage instructions apply
    • ASC Payment Group Effective Date: 7/1/2018

    HCPCS Record

    Field Name Field Value
    Healthcare Common Procedure Coding System Code Q5105
    HCPCS Sequence Number 0010
    HCPCS Record Identification Code 3 - First line of procedure record also contains detail information in positions 92-275
    HCPCS Long Description Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
    HCPCS Short Description Inj retacrit esrd on dialysi
    HCPCS Pricing Indicator Code 1 57 - Other carrier priced
    HCPCS Multiple Pricing Indicator Code A - Not applicable as HCPCS priced under one methodology
    HCPCS Medicare Carriers Manual Reference Section Number 1 4273.1
    HCPCS Coverage Code D - Special coverage instructions apply
    HCPCS ASC Payment Group Code YY
    HCPCS ASC Payment Group Effective Date 7/1/2018
    HCPCS Berenson-Eggers Type Of Service Code O1E - Other drugs
    HCPCS Type Of Service Code 1 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
    HCPCS Type Of Service Code 2 L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
    HCPCS Anesthesia Base Unit Quantity 0
    HCPCS Code Added Date 7/1/2018
    HCPCS Action Effective Date 1/1/2020
    HCPCS Action Code N - No maintenance for this code

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    This page was last updated on: 7/1/2024