OPPS Part B Drug Payment and Status Indicator Change for HCPCS Code Q5122

The April 2021 upload of the Integrated Outpatient Code Editor (IOCE) software retroactively changed the “E2” status indicator to “K” for Healthcare Common Procedure Coding System (HCPCS) code Q5122 [Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg] for dates of service between January 1 and March 31, 2021.

All Part A Medicare Administrative Contractors (MACs) are updating the January 2021 HCPCS file to include the correct Outpatient Prospective Payment System (OPPS) payment rate for Q5122 at $336.896, and the correct OPPS 340B payment rate at $253.487. The co-payment percentage is 20 percent for both rates.

OPPS providers can either adjust their claims, or contact their MACs to adjust any impacted claims.


            Last Updated Tue, 04 May 2021 17:12:49 +0000