Q5107 HCPCS Code Guide: Retacrit Billing, Units, and Coding Requirements

The Q5107 HCPCS code is used to bill the biosimilar bevacizumab-awwb, which is marketed as MVASI, for 10 mg. The drug name needs to be recognized, but it is not enough for the correct reporting. Billers need to ensure they are using the correct bevacizumab product, ensure the correct units are prescribed, support the indication, and adhere to the claim requirements by the payer.

Medicare Part A and Part B MAC claims for bevacizumab-awwb currently are captured on this code. The code is applicable to non-ophthalmologic indications and some approved ophthalmologic indications, and there are specific reporting requirements for each of these. This guide discusses the billing, units, product identification, diagnosis support, modifiers, reimbursement, documentation and common claim errors associated with this code.

What Is Q5107 HCPCS Code?

Q5107 is a HCPCS Level II code for the biosimilar injection, bevacizumab-awwb, 10 mg, MVASI. CMS clearly set out to identify this bevacizumab biosimilar with this code. The code went into effect January 1, 2019. This code is not an interchangeable product with other bevacizumab products. CMS separately codes for reference bevacizumab (J9035) and other biosimilars (with other HCPCS codes). So identifying a product is the first crucial step in accurate billing.

Quick Reference

Under CMS’ current billing article there are specific ophthalmologic billing circumstances that are identified as this code for bevacizumab-awwb.

What Drug Does Q5107 Represent?

Q5107 is the product name for bevacizumab-awwb (also sold under the brand name MVASI). It’s a biosimilar of the reference bevacizumab. The product must be double checked from the medication record before assigning this code. The term “bevacizumab” is not sufficient, as there are currently more than one product with product-specific HCPCS codes.

Q5107 Dosage and Billing Units

Q5107 is a certain amount of 10 mg per billing unit. The dose of bevacizumab-awwb should be used to determine the number of units to be given.

Use this basic calculation:

Administered dose in mg ÷ 10 mg = units

For example, if 100 mg of MVASI is administered:

100 mg ÷ 10 mg = 10 units

CMS’s current billing article states that non-ophthalmologic bevacizumab-awwb claims should be reported with this code and that the number of services should reflect the amount provided in 10 mg increments.

Common Unit Examples

The administered amount should come from the medication administration documentation. Do not calculate units solely from the vial size or package description.

How to Calculate Q5107 Units

Start with the number of doses that have been documented for the patient for MVASI. Then divide this figure by the HCPCS billing unit (10 mg).

If someone has taken 300mg in their medical history, then this would be calculated as 300mg.

300 mg ÷ 10 mg per unit = 30 units

A documented dose of 450 mg would result in:

450 mg ÷ 10 mg per unit = 45 units

The final units should agree with the medication administration record and applicable payer requirements.

Q5107 Billing Example

Suppose that someone is taking 200 mg of bevacizumab-awwb for a condition other than vision problems. The medical record contains the drug name MVASI and records 200 mg of the drug was given.

The diagnosis should support the documented indication and applicable coverage requirements. The claim should also contain documentation supporting the administered product and dosage. This example shows why the product must be confirmed before the units are calculated.

Q5107 Versus Other Bevacizumab Codes

Several HCPCS codes identify different bevacizumab products. Selecting the code based only on the generic drug name can therefore produce a coding error.

CMS’s current article identifies these product-specific codes and their applicable effective dates. Q5160 became effective for bevacizumab-nwgd on January 1, 2026. The exact product administered should drive HCPCS selection.

Q5107 Indications and Diagnosis Coding

Q5107 may be reported for covered uses of bevacizumab-awwb when the documented indication meets applicable Medicare or payer requirements. CMS’s billing article includes diagnosis-code groups supporting covered ophthalmologic and non-ophthalmologic indications. For metastatic disease, CMS also provides specific guidance regarding reporting the primary malignancy and related personal-history codes.

The diagnosis should represent the patient’s documented condition. Coders should not select a diagnosis simply because it is frequently associated with bevacizumab therapy. For oncology claims, review the clinical documentation carefully. Confirm that the diagnosis, treatment indication, and applicable payer policy are consistent.

Q5107 Medicare Billing Requirements

Medicare billing requirements can differ according to the claim type, MAC, indication, and site of service. For non-ophthalmologic claims, CMS identifies this code for bevacizumab-awwb and uses a 10 mg billing basis. For certain approved ophthalmologic indications, this code can also be reported under the specific Medicare guidance.

A Medicare claim review should confirm:

• Exact bevacizumab product
• Appropriate HCPCS code
• Administered dose
• Correct units
• Supporting diagnosis
• Medical necessity
• Applicable coverage requirements
• Site of service
• Administration coding
• Required modifiers
• Current payer instructions

This product-specific review helps prevent incorrect coding between this code and other bevacizumab codes.

Q5107 Ophthalmologic Billing

Ophthalmologic billing requires special attention because the dosage and claim reporting can differ from non-ophthalmologic services. CMS states that Part B MAC claims for approved ophthalmologic indications may use this code, with one unit per eye for the specified small-dose reporting. The intravitreal administration is reported separately with CPT 67028.

For these claims, CMS requires an appropriate site modifier when CPT 67028 is billed:

• RT for the right eye
• LT for the left eye
• 50 for bilateral services

CMS states that ophthalmologic injection claims without the required site modifier may be returned unprocessed. The drug units and administration coding should therefore be reviewed separately.

Q5107 Modifiers: Which Ones Apply?

Modifier requirements depend on the service being reported and the claim circumstances. This code itself does not require a modifier simply because it is a drug code. For ophthalmologic administration, CMS specifically requires a site modifier on CPT 67028 when reporting the intravitreal injection:

CMS states that the appropriate site modifier must be appended to CPT 67028 for unilateral or bilateral ophthalmologic administration. The modifier belongs to the administration service in this circumstance. It should not be automatically transferred to the drug line. For other claim circumstances, review the applicable Medicare or commercial payer instructions before adding modifiers.

Q5107 Wastage and JW/JZ Considerations

Drug wastage should be evaluated separately from the administered dose. When applicable Medicare rules require reporting discarded amounts from qualifying single-dose containers or single-use packages, the appropriate wastage reporting should be reviewed.

The JW modifier may apply when qualifying discarded drug is separately reportable. The JZ modifier may apply when no amount was discarded under the applicable Medicare policy. However, these modifiers should not be added automatically to every claim. The provider should verify whether the drug packaging, payment status, site of service, and current Medicare requirements make JW or JZ applicable. Documentation should distinguish the amount administered from any amount discarded.

Q5107 Administration Coding

The drug code and drug administration service represent separate billing elements. For applicable ophthalmologic claims, CMS specifically identifies CPT 67028 for the intravitreal injection. The appropriate eye modifier must accompany the administration service when required. For other routes and clinical circumstances, the applicable administration code should be selected using current CPT guidance and payer requirements. Do not assume that the same administration code applies to every claim.

Q5107 Documentation Requirements

Complete documentation should establish why the drug was administered and what product and dose were given.

Review the medical record for:

• Product name
• Generic drug name
• Bevacizumab-awwb identification
• Dose administered
• Date of service
• Route
• Clinical indication
• Supporting diagnosis
• Medical necessity
• Administration details
• Amount discarded, when applicable
• Payer-required medication documentation

For ophthalmologic services, the record should also support the treated eye and corresponding administration service. Documentation should allow the billed units to be traced back to the actual medication administration record.

Q5107 Medical Necessity

Medical necessity depends on the patient’s documented condition, treatment indication, dosage, frequency, and applicable coverage policy. CMS states that dose and frequency should follow the FDA label or recognized compendia for off-label uses. Services performed outside established parameters may be subject to medical necessity review.

For claims involving metastatic disease, CMS also provides specific diagnosis reporting guidance. When a secondary malignancy is being treated, the coding should follow the applicable CMS instructions concerning the primary malignancy and personal-history coding. Coders should therefore review both the clinical documentation and the applicable coverage policy before finalizing the diagnosis.

Q5107 Reimbursement and Medicare Payment

Q5107 reimbursement can vary according to the payer, setting, payment methodology, contract, and payment period. CMS publishes Medicare Part B drug payment limit files by payment period. The 2026 files include January, April, July, and October payment files, with revisions published when applicable. This means an older payment amount should not automatically be used for a current claim.

Q5107 Common Billing Errors

Using the Wrong Bevacizumab Code

A common problem occurs when the documentation provides only bevacizumab, without specifying the product. This code identifies bevacizumab-awwb, MVASI. Other bevacizumab products have different HCPCS codes.

Reporting Incorrect Units

This code represents 10 mg per unit. The documented administered dose must be converted into the correct number of units.

Using Vial Size Instead of Dose

The container quantity does not automatically establish the amount administered. The medication administration record should support the billed units.

Misapplying Eye Modifiers

For ophthalmologic services, RT, LT, or 50 applies to the administration code when required. The modifier should not automatically be appended to the Q5107 drug line.

Ignoring Product-Specific Codes

Each different bevacizumab biosimilar has its own HCPCS code. It is important to make sure the product is identified correctly, as this can result in inaccurate claim reporting.

Using Unsupported Diagnoses

The diagnosis should correspond with the documented indication and applicable coverage requirements.

Relying on Outdated Payment Rates

Medicare Part B drug payment limits are updated by payment period. Older payment information may not represent the current reimbursement amount.

How to Prevent Q5107 Claim Denials

A strong pre-submission review should connect the drug product with the dose, diagnosis, administration, and payer requirements.

Claim Review

Verify products: Ensure that the drug administered is bevacizumab-awwb with the trade name MVASI.

Code verification: Before using the product, determine that it applies to the specific product and claim by code verification.

Dose verification: Compare the billed dose with the medication administration record.

Unit verification: Convert the administered dose using the 10 mg billing unit.

Diagnosis verification: Confirm that the diagnosis supports the documented treatment indication.

Coverage verification: Review the applicable Medicare or commercial payer policy.

Administration verification: Confirm the correct administration code for the service.

Modifier verification: For ophthalmologic services, verify RT, LT, or 50 on CPT 67028 when applicable.

Wastage verification: Review discarded drug reporting and JW or JZ requirements when applicable.

Payment verification: Check the current Medicare payment file or commercial payer fee schedule.

Q5107 Coding Workflow: From Product to Claim

A proper workflow should be developed in a manner that mimics the real billing process. This means that units, modifiers, or diagnoses will not be assigned until confirmed.

Step 1: Identify the Exact Product

Check the medication administration record, the medication label, NDC information or other reliable documentation. Confirm the product administered is bevacizumab-awwb, MVASI.

Step 2: Match the Product to code

Check the applicability of the product/payer for HCPCS code. CMS lists this code for bevacizumab-awwb at 10 mg per unit.

Step 3: Determine the Clinical Indication

Review the provider documentation and diagnosis. Establish why MVASI was administered and whether the indication meets the applicable coverage requirements.

Step 4: Confirm the Administered Dose

Use the medication administration record to identify the actual amount administered. Do not rely solely on the vial or package size.

Step 5: Calculate Units

Divide the administered dose by 10 mg.

Example:

200 mg administered ÷ 10 mg per unit = 20 units

Step 6: Review the Billing Setting

Determine whether the service is non-ophthalmologic or ophthalmologic. The applicable Medicare reporting instructions can differ by indication and service type.

Step 7: Validate Administration Coding

For applicable ophthalmologic claims, confirm CPT 67028 and the required eye modifier. Review current CPT guidance for other administration circumstances.

Step 8: Evaluate Wastage

Determine whether any drug was discarded and whether Medicare’s JW or JZ policy applies to the specific claim.

Step 9: Validate Diagnosis and Medical Necessity

Ensure diagnosis and documentation are correct and that they are reflected in the treatment. Consider Medicare or commercial payer requirements prior to submission.

Step 10: Verify Payment Information

Check the current Medicare Part B payment limit or applicable commercial payer reimbursement information. CMS publishes payment files by quarter.

Step 11: Perform a Final Claim Audit

Compare the complete claim with the medical record.

Confirm that:

• Product matches.
• Dose matches the administration record.
• Units match the 10 mg billing basis.
• Diagnosis supports the indication.
• Administration coding is appropriate.
• Required eye modifiers are present when applicable.
• Wastage is handled correctly.
• JW or JZ is supported when applicable.
• Current payer requirements are satisfied.

This workflow creates a traceable connection between the medication administered and the final claim.

Conclusion

The product-specific HCPCS code Q5107 is for bevacizumab-awwb (also known as MVASI) and signifies 10 mg per billing unit. To report accurately, the exact bevacizumab product needs to be confirmed before calculating units or choosing claim codes for the product.

The billing process is also different depending on the clinical setting. Certain ophthalmologic claims have unit and administration requirements and non-ophthalmologic claims use the 10 mg billing unit of this code. CMS has listed CPT 67028 for intravitreal injection and specifies the use of the appropriate RT, LT, or 50 modifier.

A complete review of this code should link the identification of the product, dosage, units, indication, diagnosis, administration coding, administration modifiers, wastage, documentation and current reimbursement details. Reviewing these elements collectively will help develop a claim that is consistent with the medical record and applicable to the payers.

Frequently Asked Questions