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HCPCS Q5151 · Level II · Part B drug

HCPCS Q5151: Injection, eculizumab-aagh (epysqli), biosimilar, 2 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 Q5151

Billing unit
2 MG
Inj, eculizumab-aagh, 2 mg
ASP payment limit
$31.547
October 2026; -0.7% vs July 2026
Practitioner MUE
600
MAI 3
OPPS status
SI G
APC 0852
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS Q5151 is the Level II code for Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg, billed per 2 MG. The Medicare Part B ASP payment limit for October 2026 is $31.547 per billing unit, down 0.7% from July 2026. The practitioner MUE allows up to 600 units per date of service (MAI 3). Under OPPS it carries status indicator G in APC 0852. 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. The ASP crosswalk maps 1 NDC to it, sold as Epysqli by Nupathe Inc. 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 Q5151 at $31.547 per 2 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $31.767 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q5151
QuarterPayment limitPerCoinsurance
October 2026$31.5472 MG20%
July 2026$31.7672 MG—
CMS note: 8% of reference add-on applied

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 1 NDC from 1 labeler to Q5151. Report the NDC in the claim's drug segment and bill the number of Q5151 units that equals the quantity administered divided by 2 MG; the last column gives units per full package.

NDCs that crosswalk to Q5151
NDCDrug nameLabelerPackage sizeBilling units / package
51759-0208-13EpysqliNupathe Inc30 × 1150

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for Q5151. For practitioners the limit is 600 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 Q5151 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services6003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital6003 Date of Service Edit: ClinicalPrescribing Information
DME supplier6003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q5151 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.

Q5151 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 Q5151 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 Q5151
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeebWellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q5151 carries status indicator G and is assigned to APC 0852, with a published national unadjusted payment of $31.77. Status G marks pass-through drug payment, which is time-limited.

Common denials for Q5151 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 Q5151 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.

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Frequently asked questions — HCPCS Q5151

What does HCPCS code Q5151 describe?

Q5151 is defined by CMS as "Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg". Each billing unit represents 2 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q5151 in October 2026?

The ASP-based payment limit is $31.547 per 2 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $31.767.

How many units of Q5151 can be billed per day?

The practitioner Medically Unlikely Edit is 600 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 "Prescribing Information" as the rationale.

Which NDCs map to Q5151?

The October 2026 ASP crosswalk lists 1 NDC from 1 labeler: Epysqli (Nupathe Inc). For example NDC 51759-0208-13 is a 30 package equal to 150 billing units. The crosswalk's billing-units-per-package figure converts each package into Q5151 units.

Does Q5151 have NCCI bundling edits?

No active practitioner PTP pairs list Q5151 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 Q5151?

1 current Billing and Coding Article in the Medicare Coverage Database list Q5151, covering 5 states: (Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeeb).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. 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.