Skip to main content
HCPCS Q5124 · Level II · Part B drug

HCPCS Q5124: Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for Q5124

Billing unit
0.1 MG
Inj. byooviz, 0.1 mg
ASP payment limit
$249.493
October 2026; +3.5% vs July 2026
Practitioner MUE
10
MAI 3
OPPS status
SI K
APC 9017
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS Q5124 is the Level II code for Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg, billed per 0.1 MG. The Medicare Part B ASP payment limit for October 2026 is $249.493 per billing unit, up 3.5% from July 2026. The practitioner MUE allows up to 10 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9017. As a biosimilar it has its own code and ASP; the reference product cannot be billed under this code, and the JZ or JW modifier rules for discarded amounts apply per single-dose vial. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 2 NDCs to it, sold as Byooviz by Biogen Inc., Harrow Eye, LLC. 1 Medicare coverage article lists the code across 5 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q5124 at $249.493 per 0.1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $240.972 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q5124
QuarterPayment limitPerCoinsurance
October 2026$249.4930.1 MG20%
July 2026$240.9720.1 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 2 labelers to Q5124. Report the NDC in the claim's drug segment and bill the number of Q5124 units that equals the quantity administered divided by 0.1 MG; the last column gives units per full package.

NDCs that crosswalk to Q5124
NDCDrug nameLabelerPackage sizeBilling units / package
64406-0019-01ByoovizBiogen Inc.0.05 × 15
82667-0018-05ByoovizHarrow Eye, LLC0.05 × 15

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q5124. For practitioners the limit is 10 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for Q5124 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services103 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital103 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q5124 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

Q5124 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists Q5124 in their HCPCS tables, covering 5 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing Q5124
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Ranibizumab, Aflibercept and biosimilarsWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q5124 carries status indicator K and is assigned to APC 9017, with a published national unadjusted payment of $240.97. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for Q5124 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks Q5124 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS Q5124

What does HCPCS code Q5124 describe?

Q5124 is defined by CMS as "Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg". Each billing unit represents 0.1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q5124 in October 2026?

The ASP-based payment limit is $249.493 per 0.1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $240.972.

How many units of Q5124 can be billed per day?

The practitioner Medically Unlikely Edit is 10 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "CMS Policy" as the rationale.

Which NDCs map to Q5124?

The October 2026 ASP crosswalk lists 2 NDCs from 2 labelers: Byooviz (Biogen Inc.); Byooviz (Harrow Eye, LLC). For example NDC 64406-0019-01 is a 0.05 package equal to 5 billing units. The crosswalk's billing-units-per-package figure converts each package into Q5124 units.

Does Q5124 have NCCI bundling edits?

No active practitioner PTP pairs list Q5124 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention Q5124?

1 current Billing and Coding Article in the Medicare Coverage Database list Q5124, covering 5 states: (Billing and Coding: Ranibizumab, Aflibercept and biosimilars).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.