Cimerli (ranibizumab-eqrn) — HCPCS Q5128

About Cimerli — the first interchangeable ranibizumab biosimilar FDA verified May 2026

Cimerli (ranibizumab-eqrn) is a recombinant humanized monoclonal antibody Fab fragment that binds and inhibits vascular endothelial growth factor A (VEGF-A), manufactured by Coherus BioSciences. The FDA approved Cimerli on August 2, 2022 under BLA 761165 as a biosimilar to and interchangeable with reference Lucentis (Genentech/Roche). Cimerli is the second FDA-approved ranibizumab biosimilar and the first ranibizumab biosimilar to carry the interchangeable designation. A third interchangeable ranibizumab biosimilar, Nufymco (ranibizumab-leyk, Formycon/Bioeq), was approved December 18, 2025; its permanent HCPCS code is still pending.

Cimerli is approved for the same five indications as reference Lucentis in adult patients: neovascular (wet) age-related macular degeneration (wAMD), macular edema following retinal vein occlusion (RVO), diabetic macular edema (DME), diabetic retinopathy (DR), and myopic choroidal neovascularization (mCNV). Cimerli is supplied in two strengths and four presentations (single-dose vials and prefilled syringes for both 0.5 mg and 0.3 mg doses), giving it full label and presentation parity with the adult Lucentis label. Cimerli does not carry the pediatric retinopathy of prematurity (ROP) indication that reference Lucentis holds; the 0.2 mg ROP dose remains specific to Lucentis (J2778).

For billers and coders, the dominant facts are:

• HCPCS Q5128 uses a 0.1 mg unit basis — the same unusual basis as reference Lucentis (J2778) and the Byooviz biosimilar (Q5124). Multiply mg by 10 to get units.
• Q5128 became effective April 1, 2023 (after a brief transitional period under unclassified codes); use Q5128 for all Cimerli administrations on or after that effective date.
• Cimerli is administered by CPT 67028 (intravitreal injection) with mandatory RT or LT laterality.
• The JZ modifier applies to nearly every Cimerli claim because the vials and PFS are sized to the exact 0.05 mL injection volume — wastage is essentially zero on a clean injection.
• The interchangeable designation drives payer behavior, not coding: many 2026 commercial plans require biosimilar substitution and treat Cimerli as a preferred ranibizumab.

Ranibizumab biosimilar landscape — and competing anti-VEGFs HCPCS verified May 2026

Three FDA-approved ranibizumab biosimilars (two interchangeable) plus the reference product. The brand on the syringe determines the code — "ranibizumab" alone is not enough.

Competing intravitreal anti-VEGF agents (different molecules, different J-codes, different unit math — cross-checked because biller workflows commonly span the whole class):

Dosing per indication FDA label, BLA 761165

Source: Cimerli prescribing information (Coherus, 2022 with subsequent revisions). Cimerli has full adult label parity with reference Lucentis — five indications across two strength formulations.

NDC reference FDA NDC Directory verified May 2026

Coherus labeler code 70114. Cimerli has four presentations across two concentrations: vials and prefilled syringes (PFS) for both the 0.5 mg and 0.3 mg doses.

CPT 67028 & bilateral rules CPT verified May 2026

Cimerli, like all intravitreal ranibizumab and anti-VEGF agents, is administered under CPT 67028. Laterality is mandatory.

Bilateral same-day injections — RT/LT, not modifier 50

For bilateral Cimerli injections on the same date of service, most payers require two separate line items:

• Line 1: 67028-RT, 1 unit, full fee
• Line 2: 67028-LT, 1 unit, full fee

Some commercial payers accept the alternative single-line format with modifier 50:

• 67028-50, 1 unit, fee doubled

Per AAPC and Retina Today: check with individual payers as some may require two separate lines with -RT and -LT rather than -50. Modifier 50 is not preferred for retina; RT/LT is the safer default.

Modifiers CMS verified May 2026

RT / LT — required for laterality

Append RT (right eye) or LT (left eye) to both the Q5128 drug line and the 67028 admin line. Without laterality, payer systems can't reconcile bilateral claims and will deny one or both lines. Modifier 50 is generally not preferred for retina coding (see CPT 67028 & bilateral rules above).

E1–E4 — eyelid quadrant (occasional)

Some payers (and some non-retina ophthalmology procedures) require eyelid quadrant modifiers E1 (upper left), E2 (lower left), E3 (upper right), E4 (lower right) when the procedure is on a specific lid quadrant. For pure intravitreal injection (Cimerli under 67028), RT/LT is typically sufficient and E1–E4 do not apply — the injection is to the vitreous, not the lid. Verify per payer.

JZ — required when no drug discarded

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Cimerli vials and PFS are sized to a 0.05 mL dose, so wastage is essentially zero on a clean injection. JZ applies by default to nearly every Cimerli claim. Missing JZ on a Q5128 single-dose claim is one of the top denial reasons in 2026 retina coding.

JW — rarely applies

Use JW only if at least one billable unit (0.1 mg) was actually wasted. Because Cimerli vials and PFS are single-dose, sized exactly to the 0.05 mL injection volume, this is uncommon. If JW is appropriate, the wasted units are reported on a separate line from the administered units, with documentation in the medical record.

Modifier 25 — same-day E/M

Append modifier 25 to the E/M code when a significant, separately identifiable E/M service is performed on the same day as the Cimerli injection. Routine pre-injection workup is bundled into 67028. New clinical concerns, treatment-decision visits, or evaluation of an unrelated complaint qualify; routine "see how the eye looks before the shot" does not.

Worked example — bilateral wAMD treatment day

Patient with bilateral wAMD presenting for monthly 0.5 mg Cimerli injections, both eyes. No E/M separately identifiable. Vials drawn cleanly, no wastage.

ICD-10-CM diagnosis codes FY2026 verified May 2026

Use the most specific code supported by the encounter documentation. Laterality character must match the RT/LT modifier on 67028.

Site of care & place of service Verified May 2026

Cimerli is administered in an ophthalmology office, ophthalmology ASC, or hospital outpatient setting. Home administration does not apply for intravitreal injections.

Intravitreal injections must be performed by an ophthalmologist or qualified retina specialist in a setting with sterile injection capability. Home administration is not a valid pathway for Cimerli, so home-infusion HCPCS codes (S9329, S9379, 99601, G0089) do not apply. The only legitimate sites of care are physician office, ophthalmology-based ASC, and hospital outpatient.

Payer site-of-care steering

Both UnitedHealthcare and Aetna apply site-of-care utilization management to ophthalmology anti-VEGF injections, generally favoring office (POS 11) and ophth ASC (POS 24) over hospital outpatient (POS 19/22) due to higher facility fees. If your practice operates under a hospital's billing TIN, expect a payer challenge for hospital outpatient billing of Cimerli.

Claim form field mapping Coherus 2025 + Retina Today

CMS-1500 / 837P (physician office, ASC; POS 11/24).

Source: Retina Today — How to Create Clean Claims; Coherus / Sandoz One Source ranibizumab-eqrn billing & coding documentation.

Payer policy snapshot Reviewed May 2026

Cimerli is generally preferred at major commercial payers in 2026 thanks to its interchangeable designation and pricing. A Lucentis prior-auth request will often be redirected to Cimerli or Byooviz.

Common authorization criteria for Cimerli

• Confirmed diagnosis (wAMD, DME, DR, RVO ME, or mCNV) with imaging (OCT) and lesion documentation
• For commercial: documented bevacizumab trial OR contraindication / failure (typically ≥3 doses with OCT response data)
• Prescription written for Cimerli (or written for Lucentis with payer-driven substitution to Cimerli)
• Provider attestation of intravitreal injection competency and aseptic facility

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.

Per-dose calculation (Q2 2026)

Coverage

No NCD specific to Cimerli. The relevant MAC billing & coding article is A52451 ("Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa..."). All MACs cover Q5128 for FDA-approved on-label indications. Bill with a specific H35.32xx, E1x.31x/E1x.35x, H34.81xx, or H44.2x ICD-10. ROP is not covered for Q5128 (use reference Lucentis J2778 for ROP).

Sequestration

Medicare ASP+6% is reduced by approximately 2% sequestration on the program payment side, effectively netting closer to ASP + 4.3% on the actual paid amount. The unit price shown above is the gross ASP+6% rate; net paid will be slightly lower.

Next ASP update

ASP is updated quarterly by CMS via the Part B Drug Pricing File. Next update: July 1, 2026 for Q3 2026. The Cimerli value above will refresh automatically on this page when CMS publishes the Q3 file.

Canonical code source: HCPCSdata Q5128; CMS Part B Drug ASP Pricing File.

Patient assistance — COHERUS COMPLETE / Sandoz One Source Verified May 2026

• COHERUS COMPLETE (legacy program name; transitioning to Sandoz One Source for ranibizumab-eqrn following the 2024 divestiture): comprehensive patient support for Cimerli including benefits investigation, prior authorization assistance, copay support, and the patient assistance program (PAP).
• Commercial Copay Program: eligible commercially-insured patients may pay as little as $0 per Cimerli treatment, with annual program limits. Eligibility excludes Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, and TRICARE.
• Patient Assistance Program (PAP): free Cimerli for uninsured or underinsured patients meeting income criteria (typically ≤500% FPL; verify current threshold at enrollment).
• Enrollment & provider line: 1-888-444-3818 (COHERUS COMPLETE / Sandoz One Source ranibizumab-eqrn).
• Web: coherus.com (currently redirecting Cimerli patient services); confirm the active patient-support URL at enrollment.
• Independent foundations (Medicare): Patient Access Network (PAN) Foundation — Macular Degeneration Fund; HealthWell Foundation — verify open funds quarterly.

Common denials & how to fix them

Frequently asked questions

What is the HCPCS code for Cimerli?

Cimerli (ranibizumab-eqrn) is billed under HCPCS Q5128 — "Injection, ranibizumab-eqrn, biosimilar (Cimerli), 0.1 mg." Like reference Lucentis (J2778) and the Byooviz biosimilar (Q5124), Q5128 uses a 0.1 mg unit basis — NOT 1 mg. A 0.5 mg wAMD/RVO/mCNV dose is 5 units; a 0.3 mg DME/DR dose is 3 units. Billing Cimerli under J2778 is a coding error and an audit risk (reference Lucentis ASP runs higher than Cimerli ASP).

Cimerli vs Byooviz — both are ranibizumab biosimilars, right?

Both are FDA-approved ranibizumab biosimilars, but they use different permanent HCPCS codes and have different approved indications. Byooviz (ranibizumab-nuna, Samsung Bioepis/Biogen, FDA Sep 2021) bills under Q5124 and is approved for only the 0.5 mg dose; it does NOT carry the interchangeable designation. Cimerli (ranibizumab-eqrn, Coherus, FDA Aug 2022) bills under Q5128, carries the interchangeable designation, and has full label parity with Lucentis covering both 0.5 mg and 0.3 mg doses. Use the brand on the syringe label or NDC to determine the code; "ranibizumab" alone is not a code-determining label.

What does the interchangeable designation mean for Cimerli billing?

Per the BPCIA, an interchangeable biosimilar may be substituted for the reference product without prescriber intervention at the pharmacy level (subject to state pharmacy laws). For provider-administered buy-and-bill drugs like Cimerli, the practical impact is on payer policy: many commercial payers and PBM-aligned medical-benefit policies treat the interchangeable designation as the basis for mandatory biosimilar substitution, redirecting Lucentis requests to Cimerli (or Nufymco, the third interchangeable ranibizumab). The HCPCS code itself does not change based on interchangeability — Cimerli is always Q5128 regardless of whether it was dispensed under a Lucentis order.

Is CPT 67028 the administration code for Cimerli?

Yes. CPT 67028 — "Intravitreal injection of a pharmacologic agent (separate procedure)" — is the administration code for Cimerli (and for all other intravitreal anti-VEGF agents: Lucentis, Byooviz, Eylea, Vabysmo, Beovu). Pair 67028 with the Q5128 drug line on the same claim, and append RT (right eye) or LT (left eye) for laterality.

Are laterality modifiers (RT/LT) required on Cimerli claims?

Yes — on both the Q5128 drug line and the 67028 administration line. Without laterality, payer systems cannot reconcile unilateral vs bilateral claims and will deny one or both lines. Some payers additionally use eyelid quadrant modifiers E1–E4 for non-retina eye procedures, but for pure intravitreal injection RT/LT is typically sufficient.

Is biosimilar substitution mandatory for ophthalmology anti-VEGF in 2026?

Increasingly yes, but the mechanism is payer-driven, not regulatory. UnitedHealthcare, Aetna, and many BCBS plans now list Cimerli (Q5128) and Byooviz (Q5124) as preferred ranibizumab products, with reference Lucentis (J2778) demoted to non-preferred. A Lucentis prior-authorization request is commonly redirected to a biosimilar even after step-therapy criteria are otherwise met. Cimerli's interchangeable designation gives it a coverage edge over Byooviz at plans that distinguish interchangeable from non-interchangeable biosimilars.

Can I switch a patient from Lucentis to Cimerli mid-treatment course?

Clinically yes — Cimerli's interchangeable designation is based on the FDA's determination that switching between Cimerli and reference Lucentis produces no greater risk than continuing on Lucentis alone. Operationally, document the switch (with rationale: payer preference, cost, or biosimilar mandate), confirm the patient's coverage now lists Cimerli as preferred, and update the medication order and consent. On the claim, the date the patient first received Cimerli must use Q5128 (not J2778) for that date of service — the historical Lucentis administrations remain billed under J2778.

0.5 mg vs 0.3 mg dosing — does Cimerli cover both?

Yes. Cimerli has full label parity with reference Lucentis across both strength concentrations: 10 mg/mL (used for the 0.5 mg dose in wAMD, macular edema following RVO, and mCNV) and 6 mg/mL (used for the 0.3 mg dose in DME and diabetic retinopathy). This is a clinically important distinction from Byooviz (Q5124), which is approved only for the 0.5 mg dose — Byooviz cannot be used for DME/DR, while Cimerli can. Cimerli does not have a pediatric ROP indication; the 0.2 mg pediatric ROP dose is specific to reference Lucentis (J2778).

What is the Medicare reimbursement for Q5128?

Medicare Part B reimburses Q5128 at ASP + 6% per 0.1 mg unit. Q2 2026 ASP+6% is approximately $83.477 per unit, putting a 0.5 mg dose (5 units) at roughly $417.39 and a 0.3 mg dose (3 units) at roughly $250.43 before sequestration. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%. ASP is updated quarterly by CMS via the Part B Drug Pricing File.

Source documents

1. FDA — Biosimilar Product Information (Cimerli, ranibizumab-eqrn, BLA 761165, approved Aug 2, 2022)
   FDA approval letter and interchangeable designation
2. HCPCSdata — Q5128 "Injection, ranibizumab-eqrn, biosimilar (Cimerli), 0.1 mg"
   Canonical code descriptor and unit basis
3. AAPC — HCPCS Q5128 (Cimerli)
4. AAPC — HCPCS J2778 (reference Lucentis)
   Reference code for comparison
5. AAPC — HCPCS Q5124 (Byooviz, the non-interchangeable ranibizumab biosimilar)
6. American Academy of Ophthalmology (AAO) — Biosimilars overview
   Background on ranibizumab biosimilars (Byooviz, Cimerli, Nufymco) and ophthalmology biosimilar policy; AAO IRIS Registry tracks real-world utilization
7. CMS MCD Article A52451 — Ranibizumab and biosimilars billing & coding
   MAC billing/coding article covering ranibizumab (J2778), Cimerli (Q5128), Byooviz (Q5124), and related anti-VEGF agents
8. CMS — Medicare Part B Drug ASP Pricing File
   Q2 2026 quarterly file, effective April 1 – June 30, 2026
9. UnitedHealthcare — Ophthalmologic VEGF Inhibitors policy
   Step-therapy criteria; bevacizumab trial requirement; biosimilar preference (Cimerli/Byooviz over reference Lucentis)
10. Aetna CPB 0701 — VEGF Inhibitors for Ocular Indications
11. Retina Today — How to Create Clean Claims
    CMS-1500 field-by-field claim guidance for retina (applies to Cimerli)
12. Retina Today — The Effect of Bilateral Rules on Retina Coding
    RT/LT vs modifier 50 guidance for intravitreal anti-VEGF
13. AAPC — CPT 67028
    Intravitreal injection code descriptor and bilateral billing notes
14. Coherus BioSciences — Cimerli (ranibizumab-eqrn) product page and patient services
    Prescribing information, COHERUS COMPLETE patient support, NDCs. Following the 2024 Sandoz divestiture, patient services are transitioning to Sandoz One Source.
15. CMS Transmittal — Q5128 effective date and HCPCS coding instructions
    Q5128 effective April 1, 2023; pre-effective Cimerli claims used unclassified J3590/C9399

About this page

We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 22, 2026 — Initial publication. ASP data: Q2 2026. FDA label: BLA 761165 (five adult indications: wAMD, RVO, DME, DR, mCNV; no ROP). Biosimilar landscape: Byooviz (Q5124, Sep 2021, not interchangeable), Cimerli (Q5128, Aug 2022, interchangeable), Nufymco (Dec 2025, interchangeable, code pending). Payer policies: UHC Ophth VEGF Inhibitors, Aetna CPB 0701, Blue Shield CA. 2024 Coherus-to-Sandoz divestiture noted.

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical policy documents. We do not paraphrase from billing-software vendor blogs. When manufacturer guidance and payer policy conflict (as happens with bilateral injection coding, biosimilar substitution mandates, and step-therapy rules), we surface the conflict rather than picking a side.