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April 29, 2021

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

Retroactive changes for HCPCS code Q5122 (Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg) were implemented in April 2021.

For dates of service between January 1, 2021 and March 31, 2021:

  • The status indicator was changed from E2 (Items, codes and services for which pricing information and claims data are not available) to K (Nonpass-through drugs and nonimplantable biologicals, including therapeutic radiopharmaceuticals).

This information was published in the CMS MLN Matters article MM12175External PDF and the change was reflected in the April 2021 Integrated Outpatient Code Editor (IOCE) software.

  • CMS instructed the Medicare Administrative Contractors (MACs) to update the payment rate as follows:
    • OPPS payment quarterly rate = $336.896
    • OPPS 340B payment rate = $253.487
    • The copayment percentage is 20 percent for both the regular OPPS payment rate and the OPPS 340B payment rate.

Providers may adjust impacted claims or CGS will adjust impacted claims when brought to our attention.


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