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See a sample rate comparisonHCPCS Q5130 (Fylnetra) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Cancer, Vision and Other Associated Drugs |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for Q5130 |
| Medicare Payment Limit | $137.965  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS Q5130 by major payers:
$203.46
$201.11
$204.81
$197.68
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HCPCS Q5130
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$459.36Published rateAnn Steck
$233.86Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$201.97Published rateUniversity Healthcare System, L.C., Tulane Lakeside Hospital
$194.05Published rateKarlie Ryan
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$186.19Published rate
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See a sample payer proposalHCPCS Q5130 vs. Other Cancer, Vision and Other Associated Drugs Codes
The HCPCS Q5130 code is part of the Temporary Codes services used for Cancer, Vision and Other Associated Drugs. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS Q5130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| Q5129-HCPCS | Low | Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg |
| Q5130-HCPCS | Moderate | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q5130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q5130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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