HCPCS code Q5130: Pegfilgrastim-pbbk, per 0.5 mg2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for Q5130 in California.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What Q5130 covers

Pegfilgrastim-pbbk (Fylnetra) is a long-acting granulocyte colony-stimulating factor biosimilar given by subcutaneous injection. Oncology practices use it to reduce the risk of febrile neutropenia in patients receiving myelosuppressive chemotherapy. The drug supports neutrophil recovery; the treating team selects and documents the product and administered dose.

Q5130 identifies the drug, not the injection-administration service. Its unit represents 0.5 mg, so a documented 6 mg dose corresponds to 12 units. CMS assigns physician fee schedule status E, meaning the drug is excluded from the physician fee schedule. When Medicare covers it, the payment method is generally the Part B drug method using CMS quarterly ASP drug pricing files. Coverage is left to the Medicare contractor’s judgment.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where Q5130 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the Q5130 rate is calculated

Each of Q5130’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for Q5130

Q5130 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Q5130 compared with similar codes

How to choose

Q5120Pegfilgrastim-bmezPer 0.5 mg

Q5120 identifies pegfilgrastim-bmez, not Fylnetra. Select the code matching the pegfilgrastim product administered.

Q5122Nyvepria injectionPer 0.5 mg

Q5122 identifies Nyvepria, a different pegfilgrastim product. Q5130 is specific to pegfilgrastim-pbbk (Fylnetra).

Q5127Stimufend injectionPer 0.5 mg

Q5127 identifies Stimufend, not Fylnetra. These product-specific codes are distinguished by the pegfilgrastim product administered.

Codes related to Q5130

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates