## **What is the HCPCS Code Q5105?**
HCPCS Code Q5105 is used to report the injection of epoetin alfa-epbx (Retacrit), a biosimilar erythropoiesis-stimulating agent (ESA), in 100-unit increments, for the treatment of symptomatic anemia in patients with End Stage Renal Disease (ESRD) on dialysis.
Epoetin alfa-epbx stimulates red blood cell production and helps manage anemia-related symptoms in individuals with chronic kidney disease (CKD) and chronic renal failure. By improving hemoglobin levels, this therapy reduces the need for frequent blood transfusions and lowers risks associated with severe anemia.
While Q5105 is specifically limited to ESRD on dialysis, epoetin alfa agents are also used in other chronic diseases classified as causing anemia, such as HIV infection, hepatitis C treatment, cancer chemotherapy, and antineoplastic chemotherapy. However, those scenarios are reported with other codes (e.g., Q5106 or J-codes).
## **HCPCS code Q5105 documentation requirements**
To ensure accurate reporting and compliance, the medical record must include:
- Diagnosis codes confirming ESRD on dialysis, like N18.6 ESRD.
- Documentation of anemia-related symptoms, hemoglobin/hematocrit values, and lab monitoring of serum ferritin and transferrin saturation.
- The drug name (epoetin alfa-epbx, Retacrit), total dosage, and correct billing units (1 unit = 100 units).
- Route of administration (intravenous or subcutaneous), which may require modifiers (e.g., JA or JB).
- Clinical justification to avoid blood transfusions and minimize risks such as allergic reactions, adverse reactions, uncontrolled hypertension, or neutralizing antibodies anemia.
## **HCPCS code Q5105 billing requirements**
When billing Q5105, follow these rules:
- Report the correct number of billing units (e.g., 2,000 units administered = 20 units billed).
- Use appropriate modifiers for drug wastage (JW for discarded drug, JZ if none discarded).
- For ESRD claims, submit through the ESRD Prospective Payment System (PPS), where ESA drugs are included in the bundled payment (not separately payable under Part B).
- EnsureICD-10 codes for ESRD-related anemia are included, and confirm that medical necessity is supported by documented anemia severity and treatment goals.
- For non-ESRD anemia indications such as chemotherapy-induced anemia, cancer chemotherapy, HIV infection, or hepatitis C treatment, use alternative codes like Q5106 or J-codes, since Q5105 is strictly ESRD-dialysis only.
## **Other relevant codes**
- Q5106 - Injection, epoetin alfa-epbx (Retacrit), non-ESRD use, 1,000 units
- Q4081 - Injection, epoetin alfa, 100 units for ESRD on dialysis
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