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HCPCS Code HCPCS Unit HCPCS Code Descriptor
Q5111 0.5 MG Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg
Manufacturer Brand Name Short Description
Coherus Biosciences Inc UDENYCA Injection, udenyca 0.5 mg
  <
November
2020
December
2020
January
2021
February
2021
March
2021
April
2021
May
2021
June
2021
July
2021
August
2021
September
2021
October
2021
>
Total NDC's Aligned to this HCPCS Code
  1 1 1 1 1 1 1 1 1 1 1 1  
ASP: Average Sales Price   $270.45 $270.45 $252.63 $252.63 $252.63 $237.08 $237.08 $237.08 $237.49 $237.49 $237.49 $209.79  
ASP+4.3%: Effective Payment Limit
  $282.08 $282.08 $263.49 $263.49 $263.49 $247.27 $247.27 $247.27 $247.70 $247.70 $247.70 $218.81  
ASP+6%: Medicare Payment Limit   $286.67 $286.67 $267.79 $267.79 $267.79 $251.30 $251.30 $251.30 $251.74 $251.74 $251.74 $222.38  
APC: Ambulatory Procedure Code Payment Limit   $286.67 $286.67 $267.79 $267.79 $267.79 $251.30 $251.30 $251.30 $251.74 $251.74 $251.74 $222.38  
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