How much does Medicare pay for HCPCS Q5122?

Medicare allowed an average of $72.46 per service and paid $57.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $808.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q5122?

Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg. It was billed 21,968 times to 993 Medicare beneficiaries by 66 providers in 2024.

Which specialty bills Q5122 most?

Hematology-Oncology, with 16,748 services from 51 clinicians. Next are Medical Oncology, Internal Medicine, Hematology.

HCPCS Q5122

Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg

$72.46Medicare-allowed amount per service, averaged across 21,968 services

Providers submitted

$808.56

Asking price, not received

Medicare allowed

$72.46

The fee schedule figure

Medicare paid

$57.46

Balance is patient coinsurance

Providers submitted an average of $808.56 for this code and Medicare allowed $72.46 — 11.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $57.46 (79%); the rest is the patient’s coinsurance and deductible.

Services: 21,968
Beneficiaries: 993
Providers billing it: 66
Total allowed: $1,591,801

What Medicare pays for HCPCS Q5122

Across 21,968 services billed by 66 providers to 993 beneficiaries, Medicare allowed an average of $72.46 per service. That is 22.1 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills Q5122

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	16,748	760	$72.89	51
Medical Oncology	2,376	110	$72.09	6
Internal Medicine	1,248	57	$66.94	4
Hematology	792	39	$73.25	3
Gynecological Oncology	516	12	$72.19	1
Hematopoietic Cell Transplantation and Cellular Therapy	288	15	$72.75	1

Q5122 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Illinois	6,198	$71.93	$57.26	12
South Carolina	3,328	$76.01	$61.59	11
Virginia	3,204	$68.81	$54.51	12
Maryland	2,460	$76.69	$61.14	8
Minnesota	2,400	$72.58	$57.78	5
Oregon	1,260	$76.10	$60.35	6
Alabama	1,020	$71.02	$56.26	3
Arizona	696	$72.22	$57.54	2
North Carolina	348	$61.72	$48.14	1
Texas	276	$70.78	$55.70	1
Nevada	240	$64.23	$51.17	1
Indiana	192	$77.19	$59.56	1
Pennsylvania	180	$61.47	$44.25	1
Colorado	144	$61.40	$47.68	1
Michigan	22	$0.01	$0.01	1

Related codes

Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram$0.27
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram$0.48
Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram$0.32
Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use$7.27
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg$227.58
Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mg$39.68
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg$63.66
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg$20.05
Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mg$29.21
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg$57.38
Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg$25.75
Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg$169.39

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.