Q5098 — Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
Q5098 is a HCPCS Level II code for injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg. It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of Q5098 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 520 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 520 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 520 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for Q5098
- Long descriptor
- Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
- Short descriptor
- Inj ustekinumab-srlf, 1 mg
- Added
- July 1, 2025
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to Q5098
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q5098 is not quite right, the correct code is very often within a few positions of it.
- Q5003Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)
- Q5004Hospice care provided in skilled nursing facility (snf)
- Q5005Hospice care provided in inpatient hospital
- Q5006Hospice care provided in inpatient hospice facility
- Q5007Hospice care provided in long term care facility
- Q5008Hospice care provided in inpatient psychiatric facility
- Q5009Hospice or home health care provided in place not otherwise specified (nos)
- Q5010Hospice home care provided in a hospice facility
- Q5099Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg
- Q5100Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
- Q5102Injection, infliximab, biosimilar, 10 mgterminated
- Q5103Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
- Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
- Q5105Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
- Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Questions about Q5098
What is HCPCS code Q5098?
Q5098 is a HCPCS Level II code for injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg. It sits in the Temporary Codes section.
Does Medicare cover Q5098?
The CMS HCPCS file marks Q5098 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is Q5098 paid under the physician fee schedule?
Q5098 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).