HCPCS code Q5130: Pegfilgrastim-pbbk, per 0.5 mg2026 Medicare rate & RVUs in Missouri
Product-specific HCPCS code for pegfilgrastim-pbbk, reported by oncology practices for the biosimilar drug used to reduce chemotherapy-associated neutropenia.
CMS doesn’t publish an office rate for Q5130 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | Unavailable |
| Metropolitan St. Louis, MO | Unavailable | Unavailable |
| Rest of Missouri | Unavailable | Unavailable |
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.
How the rate is built · Q5130
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · Q5130
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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Q5130 isn’t priced in this setting.
Q5130 compared with similar codes
Compare codes · National
4 codes, side by side
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.
Q5130 billing questions
When should a biller use Q5130 rather than another pegfilgrastim code?
Use Q5130 for the pegfilgrastim-pbbk product, Fylnetra. Other pegfilgrastim products have their own product-specific codes.
How many units represent a 6 mg dose?
Each unit represents 0.5 mg, so 6 mg equals 12 units. Report units based on the dose administered and documented.
Does Q5130 include the injection administration?
No. Q5130 identifies the drug. Report an administration service separately when applicable.
How does Medicare treat Q5130?
CMS excludes it from the physician fee schedule with status E. When covered, it is generally paid under the Part B drug method using quarterly ASP pricing files; the Medicare contractor determines coverage.
What should the record support for Q5130?
Document the Fylnetra product, the administered dose, and the clinical treatment context, such as use to reduce chemotherapy-associated febrile neutropenia.
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
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