Filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym™) HCPCS code Q5110: Billing Guidelines

<p>Effective with date of service Oct 3, 2018, the NC Medicaid and Health Choice&nbsp;programs cover filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym) for use in the Physician Administered Drug Program when billed with HCPCS code Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram. Nivestym is available in a single-dose prefilled syringe containing either 300 mcg/0.5 mL or 480 mcg/0.8 mL.</p>

Author: GDIT, (800) 688-6696

Effective with date of service Oct 3, 2018, the NC Medicaid and Health Choice (NCHC) programs cover filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram. Nivestym is available in a single-dose prefilled syringe containing either 300 mcg/0.5 mL or 480 mcg/0.8 mL.

It is indicated to:

  • Decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever.
  • Reduce the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of patients with acute myeloid leukemia (AML).
  • Reduce the duration of neutropenia and neutropenia-related clinical sequelae‚ e.g.‚ febrile neutropenia, in patients with nonmyeloid malignancies undergoing myeloablative chemotherapy followed by bone marrow transplantation (BMT).
  • Mobilize autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis.
  • Reduce the incidence and duration of sequelae of severe neutropenia (e.g.‚ fever‚ infections‚ oropharyngeal ulcers) in symptomatic patients with congenital neutropenia‚ cyclic neutropenia‚ or idiopathic neutropenia.

Recommended Dose: 

  • Patients with cancer receiving myelosuppressive chemotherapy or induction and/or consolidation chemotherapy for AML: Recommended starting dose is 5 mcg/kg/day subcutaneous injection, short intravenous infusion (15 to 30 minutes), or continuous intravenous infusion.
  • Patients with cancer undergoing bone marrow transplantation: 10 mcg/kg/day given as an intravenous infusion no longer than 24 hours.
  • Patients undergoing autologous peripheral blood progenitor cell collection and therapy: 10 mcg/kg/day subcutaneous injection for at least four days before first leukapheresis procedure and continue until last leukapheresis.
  • Patients with congenital neutropenia: Recommended starting dose is 6 mcg/kg as a subcutaneous injection twice daily.
  • Patients with cyclic or idiopathic neutropenia: Recommended starting dose is 5 mcg/kg as a single subcutaneous injection daily.

See full prescribing information for further detail.

For Medicaid and NCHC Billing

  • The ICD-10-CM diagnosis code(s) required for billing are: Do not restrict based on ICD-10 for oncology diagnosis. Cancer therapy and related ICD-10 codes may include  C00 - D49; T86.5 Complications of stem cell transplant (complications from stem cells from peripheral blood, umbilical blood); T86.00 - Unspecified complication of bone marrow transplant, T86.01 - bone marrow transplant rejection, T86.02 - bone marrow transplant failure, T86.03 - bone marrow transplant infection, T86.09 - other complications of bone marrow transplant; D70.0 - Congenital agranulocytosis; D70.1 - Agranulocytosis secondary to cancer chemotherapy; D70.2 - Other drug-induced agranulocytosis; D70.3 - Neutropenia due to infection; D70.4 - Cyclic neutropenia; D70.8 - Other neutropenia; D70.9 - Neutropenia, unspecified; T45.1X5A - Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter; T45.1X5D - Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter; T45.1X5S - Adverse effect of antineoplastic and immunosuppressive drugs, sequela
  • Providers must bill with HCPCS code: Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram
  • One Medicaid and NCHC unit of coverage is: 1 microgram
  • Maximum reimbursement rate per unit is: $0.79
  • Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are: 00069-0291-01, 00069-0291-10, 00069-0292-01, 00069-0292-10
  • NDC units should be reported as "UN1".
  • For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
  • For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy No. 1B, Attachment A, H.7 on NC Medicaid's website.
  • Providers shall bill their usual and customary charge for non-340B drugs.
  • PADP reimburses for drugs billed for Medicaid and NCHC beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
  • The fee schedule for the PADP is available on NC Medicaid's PADP web page.

*Information current as of Nov. 26, 2018 and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.

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