Q5106 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Q5106 is a HCPCS Level II code for injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units. It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
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 Q5106 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
- 60 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 60 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 Q5106
- Long descriptor
- Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
- Short descriptor
- Inj retacrit non-esrd use
- Added
- July 1, 2018
- 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 Q5106
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q5106 is not quite right, the correct code is very often within a few positions of it.
- Q5098Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
- 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
- Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
- Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
- Q5109Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mgterminated
- Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
- Q5112Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg
- Q5113Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg
- Q5114Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg
Questions about Q5106
What is HCPCS code Q5106?
Q5106 is a HCPCS Level II code for injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units. It sits in the Temporary Codes section.
Does Medicare cover Q5106?
The CMS HCPCS file marks Q5106 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is Q5106 paid under the physician fee schedule?
Q5106 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).