Neulasta family (pegfilgrastim) — J2506, Q5108, Q5111, Q5120, Q5122, Q5125

Six pegfilgrastim products — the disambiguation table CMS HCPCS + FDA verified May 2026

One reference product and five FDA-approved biosimilars. All share one unit basis (0.5 mg), one flat adult dose (6 mg = 12 units), and one route (SC). Each has its own HCPCS code, NDCs, manufacturer, and ASP.

Pegfilgrastim has no FDA boxed warning. Warnings & Precautions on every product label cover splenic rupture, ARDS, anaphylaxis/serious allergic reactions, sickle cell crises (avoid in SCD), glomerulonephritis, leukocytosis, capillary leak syndrome, and possible MDS/AML risk with chronic use.

Onpro On-body Injector vs. prefilled syringe FDA labels + Amgen reference 2025–2026

Same drug, same dose, same J2506 code — different delivery device and admin setting. Onpro is unique to the Neulasta brand; biosimilars are prefilled syringe only.

Pegfilgrastim vs. filgrastim — long-acting vs. short-acting G-CSF FDA labels + NCCN HGF Guidelines

Same drug class, different dosing schedules and HCPCS codes. Newer biosimilar-preferred policies often steer both pegfilgrastim and filgrastim. Cross-link: Neupogen / filgrastim biosimilars (J1442).

Per NCCN Hematopoietic Growth Factors Guidelines, both pegfilgrastim and filgrastim (and their biosimilars) are recommended for primary prophylaxis of febrile neutropenia in patients receiving chemotherapy regimens with febrile neutropenia incidence ≥20%. Pegfilgrastim is the more common choice for q3-week regimens because of the single-dose convenience; filgrastim is preferred for shorter-cycle regimens or when flexibility in duration is needed.

Dosing & timing FDA labels verified 2025–2026

Single flat dose for adults; weight-based for pediatric patients under 45 kg. One dose per chemo cycle. Do NOT administer within 14 days before next chemo.

NDC reference — all six products FDA NDC Directory verified May 2026

Pad to 11 digits with a leading zero in the appropriate segment for CMS-1500 Box 24A. Each manufacturer uses a distinct labeler code.

Neulasta (J2506) — Amgen labeler 55513

Fulphila (Q5108) — Mylan labeler 67457 (verify with current FDA NDC Directory)

Verify current Mylan/Viatris labeler (49502 historical, 67457 current per recent listings) and 6 mg/0.6 mL PFS NDC variants at billing time. Pad to 11 digits per CMS rules.

Udenyca (Q5111) — Coherus labeler 70114

Includes Udenyca PFS and Udenyca Onbody / autoinjector device variants. Verify exact NDC for the device variant administered.

Ziextenzo (Q5120) — Sandoz labeler 61314

6 mg/0.6 mL single-dose PFS. Verify current NDC (Sandoz pegfilgrastim-bmez listing).

Nyvepria (Q5122) — Pfizer labeler 0069

6 mg/0.6 mL single-dose PFS. Pfizer labeler pads from 0069 to 00069 for 11-digit NDC.

Stimufend (Q5125) — Fresenius Kabi labeler 63323

6 mg/0.6 mL single-dose PFS. Verify current NDC variant (pegfilgrastim-fpgk).

Administration codes CPT verified May 2026

Pegfilgrastim is biller-classified as a chemotherapeutic agent for SC admin even though it is supportive care. Onpro on-body injector self-administered at home has no separate admin code billed.

Why 96401 (chemo SC) and not 96372 (therapeutic SC)

CMS classifies pegfilgrastim under the chemotherapy administration umbrella for HCPCS-driven admin coding because the drug is delivered as part of a chemotherapy supportive care regimen. The CPT chemo SC code (96401) carries higher RVU than the non-chemo SC injection code (96372). Some commercial payers contest the chemo classification on the rationale that pegfilgrastim is supportive care, not antineoplastic, and recode to 96372 — verify per payer.

Onpro device application

Application of the Onpro on-body injector at the end of the chemotherapy session is not separately billable as an administration service. The device is part of the J2506 drug supply. The actual SC injection occurs ~27 hours later in the patient's home with no provider present, so no admin code is appropriate. Bill only J2506 (12 units) on the date the device delivers the dose.

Modifiers — JZ, JW, and 340B CMS verified May 2026

JZ applies to nearly every pegfilgrastim claim because of the matched-vial/syringe design. JW is rare and only relevant in unusual partial-dose scenarios.

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. For pegfilgrastim, JZ applies essentially every time: the 6 mg/0.6 mL prefilled syringe is matched to the standard 6 mg dose, and the entire syringe is delivered. Append JZ to the J2506/Q5108/Q5111/Q5120/Q5122/Q5125 line on every adult claim.

JW — rare for pegfilgrastim

Because pegfilgrastim is supplied as a single-dose 6 mg PFS matched to the standard adult dose, vial-level wastage is rare. JW would apply only in unusual scenarios (e.g., a pediatric weight-based dose where the full PFS volume could not be safely administered). Even in pediatric weight-based dosing, the standard practice is to deliver the full 6 mg PFS once the patient reaches 45 kg, which removes the waste scenario. If JW applies in your specific case, bill discarded units on a separate line and document waste in the chart per CMS rules.

JG / TB — 340B drug pricing

Hospitals that purchase pegfilgrastim through 340B and bill Medicare report the JG modifier (acute-care hospitals) or TB modifier (rural sole community / critical-access hospitals), per CMS guidance. Most infusion suites do not use 340B pricing; only the hospital-outpatient setting does.

Modifier 25 — same-day E/M

Append modifier 25 to the same-day E/M code if a significant, separately identifiable evaluation occurred (e.g., chemo response assessment that drives next-cycle decision). Routine pre-injection check-in is bundled into the admin code.

ICD-10-CM diagnosis codes FY2026 verified May 2026

Pair the primary cancer diagnosis with one or more neutropenia codes. Use the most specific codes supported by chart documentation.

Site of care & place of service Verified May 2026

SC injection in clinic (POS 11/49) is the dominant pattern. Onpro on-body injector enables home self-administration without a return visit. Hospital outpatient (POS 19/22) is unusual for routine cycles.

Payer site-of-care steering

UnitedHealthcare, Aetna, Cigna, and most BCBS plans apply site-of-care UM to high-cost specialty drugs. Pegfilgrastim is generally low-friction at office (POS 11) and AIC (POS 49) because it is a brief SC injection with no infusion time. Onpro adoption supports POS 12 (home) without site-of-care friction. HOPD billing for pegfilgrastim alone is uncommon and may trigger site-of-care denial absent justification.

Claim form field mapping Amgen + biosimilar mfr billing PDFs

CMS-1500 / 837P (physician office or AIC; POS 11/49) example for a 6 mg in-clinic SC dose of J2506.

Source: Amgen Neulasta & Onpro billing references; biosimilar manufacturer billing PDFs (Mylan Fulphila, Coherus Udenyca, Sandoz Ziextenzo, Pfizer Nyvepria, Fresenius Kabi Stimufend).

Payer policy snapshot — biosimilar preference 2026 Reviewed May 2026

National payers have moved to biosimilar-preferred or biosimilar-mandated policies for pegfilgrastim. Reference Neulasta now requires step therapy at most major payers.

2026 trend across national payers

Pegfilgrastim biosimilar uptake has been the most successful of all biosimilar classes since launch, with biosimilar share consistently above 70% of new starts at most national payers. The 2026 picture is one of biosimilar mandate rather than preference at UHC, Aetna, Cigna, and most BCBS plans — reference Neulasta is reserved for documented biosimilar failure or contraindication. Onpro on-body injector is Neulasta-only (no biosimilar OBI exists), so plans that require biosimilars also reject the Onpro delivery convenience for new starts.

What to document for step-therapy approval

• Brand of pegfilgrastim biosimilar tried (Fulphila, Udenyca, Ziextenzo, Nyvepria, or Stimufend), HCPCS code, dates of administration
• Number of cycles trialed (most policies: at least one full cycle)
• Documented intolerance, allergic reaction, or inadequate response (objective measures: ANC nadir, time-to-recovery, FN occurrence)
• For Onpro requests: clinical justification beyond device convenience (e.g., adherence concern, mobility limitation, transportation barrier — recognized only by some plans)

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. All six pegfilgrastim codes refresh together each quarter.

Cross-product price comparison (Q2 2026 ASP+6%)

Note: cells marked "verify ASP" indicate the code is not present in the current CareCost ASP snapshot at page-build time. Reference the CMS Part B ASP file directly for those codes; biosimilar pegfilgrastim ASPs consistently fall below reference Neulasta J2506.

Coverage

No NCD specific to pegfilgrastim as a class. Each MAC publishes a billing & coding article covering G-CSF agents (filgrastim, pegfilgrastim, and biosimilars) with covered ICD-10 ranges. All MACs cover J2506 and the five biosimilar codes (Q5108, Q5111, Q5120, Q5122, Q5125) for the FDA-approved chemotherapy prophylaxis indication when paired with an appropriate primary cancer code and chemo encounter (Z51.11).

Canonical code source: CMS HCPCS quarterly update file.

Patient assistance — one program per manufacturer Manufacturer sites verified May 2026

• Neulasta (J2506) — Amgen Assist 360: Phone 1-888-427-7478. Co-pay program for eligible commercially-insured patients (annual cap varies by program year). Amgen Safety Net Foundation for free drug to qualifying uninsured patients. Independent foundations (PAN, HealthWell) for Medicare patients — verify open funds quarterly.
• Fulphila (Q5108) — Mylan/Viatris: ViatrisAdvocate (Mylan Co-pay Solutions). Verify current program contact and eligibility at billing time.
• Udenyca (Q5111) — Coherus COMPLETE: Coherus patient support program for Udenyca with copay assistance, free trial program, and PAP. 1-844-483-3692 (verify current).
• Ziextenzo (Q5120) — Sandoz One Source: Phone 1-844-726-3691. Co-pay support and patient assistance for eligible patients. Same hub as other Sandoz biosimilars.
• Nyvepria (Q5122) — Pfizer Patient Assistance: Pfizer Oncology Together for support coordination. Pfizer Patient Assistance Program for free drug to qualifying uninsured patients.
• Stimufend (Q5125) — Fresenius Kabi: Stimufend patient support program. Verify current contact and eligibility (program name and phone may have updated since launch).

Common denials & how to fix them

Frequently asked questions

What are the HCPCS codes for pegfilgrastim?

There are six pegfilgrastim HCPCS codes: J2506 (Neulasta and other non-biosimilar reference pegfilgrastim — J2506 also functions as an NOC bucket for non-biosimilar pegfilgrastim), Q5108 (Fulphila — pegfilgrastim-jmdb biosimilar from Mylan/Biocon), Q5111 (Udenyca — pegfilgrastim-cbqv biosimilar from Coherus), Q5120 (Ziextenzo — pegfilgrastim-bmez biosimilar from Sandoz), Q5122 (Nyvepria — pegfilgrastim-apgf biosimilar from Pfizer), and Q5125 (Stimufend — pegfilgrastim-fpgk biosimilar from Fresenius Kabi). All six share the same billing unit basis: 1 unit = 0.5 mg.

How many units do I bill for a pegfilgrastim dose?

All six pegfilgrastim codes use 1 unit = 0.5 mg, NOT 1 mg. The standard adult dose is 6 mg SC once per chemotherapy cycle, which equals 12 units. Pediatric patients under 45 kg receive 0.1 mg/kg (max 6 mg) — calculate then divide by 0.5 to get units. The biggest billing trap is defaulting to 1 mg per unit (which would under-bill 12-unit doses as 6 units).

Is Neulasta Onpro the same drug as Neulasta prefilled syringe?

Yes. Neulasta Onpro On-body Injector (OBI) is the same pegfilgrastim drug at the same 6 mg dose, billed under the same HCPCS code (J2506). The difference is the delivery device: Onpro is a wearable patch applied to the patient at the end of chemotherapy that auto-injects approximately 27 hours later (eliminating a return visit). Prefilled syringe is administered manually in clinic ~24 hours after chemo. Same J-code, same units, same ASP — different administration setting and admin code.

What administration code applies to pegfilgrastim?

For in-clinic SC injection (PFS), bill 96401 (chemotherapy administration, subcutaneous, non-hormonal antineoplastic). Pegfilgrastim is biller-classified as a chemotherapeutic agent for admin purposes even though it is supportive care. Some payers downcode to 96372 (therapeutic SC injection) — verify per payer. For Neulasta Onpro On-body Injector, no separate admin code is billed when the patient self-administers at home via the wearable device — only J2506 is billable on the date the device fires the dose.

Why do most 2026 payers prefer pegfilgrastim biosimilars over reference Neulasta?

Pegfilgrastim biosimilars are substantially cheaper than reference Neulasta. UnitedHealthcare, Aetna, Cigna, and most BCBS plans now mandate a biosimilar (Q5108, Q5111, Q5120, Q5122, or Q5125) before reference Neulasta J2506 for new starts. Each biosimilar has its own HCPCS code, NDC, and ASP — billing J2506 when the patient received Udenyca (Q5111) is a denial trigger. Onpro is Neulasta-only, so the biosimilar mandate generally rejects the device-convenience benefit for new starts.

How is pegfilgrastim different from filgrastim?

Pegfilgrastim (Neulasta + biosimilars, J2506 / Q5108 / Q5111 / Q5120 / Q5122 / Q5125) is the long-acting pegylated form: a single 6 mg SC dose given approximately 24 hours after chemotherapy covers a full chemo cycle (typically q21 days). Filgrastim (Neupogen + biosimilars, J1442 / Q5101 Zarxio / Q5110 Nivestym / Q5125 Releuko historically) is short-acting and requires daily SC injections for 5–7 days per cycle. See the pegfilgrastim vs filgrastim section and our Neupogen page.

When during a chemotherapy cycle should pegfilgrastim be administered?

Pegfilgrastim should be given approximately 24 hours after completion of myelosuppressive chemotherapy. Per the FDA label, do NOT administer pegfilgrastim within 14 days before the next chemotherapy cycle — concurrent or near-concurrent dosing with cytotoxic chemo can amplify myelosuppression. The Onpro on-body injector solves the 24-hour return-visit problem by auto-injecting at the home approximately 27 hours after the device is applied at the end of the chemo session.

What is the Q2 2026 Medicare reimbursement for J2506 Neulasta?

Q2 2026 ASP + 6% for J2506 (reference Neulasta) is approximately $127.379 per 0.5 mg unit. The standard 6 mg SC dose = 12 units × $127.379 ≈ $1,528.55 before sequestration. Biosimilars are substantially cheaper (Ziextenzo Q5120 at $119.637/unit per the current snapshot). ASP refreshes quarterly — see the live snapshot above.

Does the JZ modifier apply to pegfilgrastim?

Yes. Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Pegfilgrastim ships as a 6 mg/0.6 mL single-dose prefilled syringe matched to the standard 6 mg dose — the entire syringe is administered, so JZ applies and JW (waste) is rare. JW would apply only in unusual partial-pediatric weight-based dose scenarios.

What FDA warnings & precautions apply to pegfilgrastim?

Pegfilgrastim has no FDA boxed warning, but the label carries Warnings & Precautions for: splenic rupture (rare but reported), acute respiratory distress syndrome (ARDS), serious allergic reactions including anaphylaxis, sickle cell crises in patients with sickle cell disease (avoid in SCD), glomerulonephritis, leukocytosis, capillary leak syndrome, and possible MDS/AML risk in chronic use. Do not administer within 14 days before next chemotherapy.

Source documents

1. AAPC — HCPCS J2506 (pegfilgrastim, excludes biosimilar)
   Code descriptor and crosswalk reference
2. AAPC — HCPCS Q5108 (Fulphila / pegfilgrastim-jmdb)
   Biosimilar code descriptor (Mylan/Biocon)
3. AAPC — HCPCS Q5111 (Udenyca / pegfilgrastim-cbqv)
   Biosimilar code descriptor (Coherus)
4. AAPC — HCPCS Q5120 (Ziextenzo / pegfilgrastim-bmez)
   Biosimilar code descriptor (Sandoz)
5. AAPC — HCPCS Q5122 (Nyvepria / pegfilgrastim-apgf)
   Biosimilar code descriptor (Pfizer)
6. AAPC — HCPCS Q5125 (Stimufend / pegfilgrastim-fpgk)
   Biosimilar code descriptor (Fresenius Kabi); verify current descriptor in HCPCS quarterly file
7. FDA Neulasta label (BLA 125031, recent revision)
   Reference pegfilgrastim prescribing information; W&P; HSARS indication
8. Amgen — Neulasta HCP resources (incl. Onpro on-body injector reference)
   Onpro device application protocol; failure / replacement guidance
9. Amgen Assist 360 — Neulasta patient support
   Co-pay program and PAP coordination · 1-888-427-7478
10. Mylan/Viatris — Fulphila resources
    Q5108 biosimilar dosing and admin reference
11. Coherus — Udenyca HCP resources
    Q5111 biosimilar dosing & Coherus COMPLETE patient support
12. Sandoz — Ziextenzo product information
    Q5120 biosimilar dosing reference; Sandoz One Source patient support
13. Pfizer — Nyvepria medical information
    Q5122 biosimilar dosing & admin reference
14. Fresenius Kabi — Stimufend product page
    Q5125 biosimilar dosing & admin reference
15. NCCN — Hematopoietic Growth Factors Clinical Practice Guidelines
    Primary FN prophylaxis recommendations; pegfilgrastim vs filgrastim selection
16. UnitedHealthcare — Commercial Medical Drug policies (oncology supportive care)
    2025–2026 biosimilar-preferred designation; step therapy criteria
17. CMS — Medicare Part B Drug ASP Pricing File
    Q2 2026 quarterly file (J2506, Q5108, Q5111, Q5120, Q5122, Q5125)
18. CMS — HCPCS quarterly update file
    Canonical HCPCS code source for pegfilgrastim family
19. CMS — JW / JZ modifier guidance
    Single-dose-container waste reporting (effective 7/1/2023)

About this page

We maintain this page as a living reference for the entire pegfilgrastim family. Medicare ASP pricing for all six HCPCS codes (J2506, Q5108, Q5111, Q5120, Q5122, Q5125) 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 manufacturer guide, FDA label, or major payer policy changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 2, 2026 — Initial publication of the six-product pegfilgrastim family reference. ASP data: Q2 2026 (J2506, Q5120 confirmed; remaining biosimilars marked verify-ASP). Payer policies: UnitedHealthcare commercial 2025–2026 biosimilar-preferred update, UHC MA Part B step therapy, Aetna and Cigna oncology supportive care policies. Onpro on-body injector vs PFS section, pegfilgrastim vs filgrastim cross-link to Neupogen page.

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File for J2506 and Ziextenzo (Q5120); biosimilar codes not in the current snapshot are flagged "verify ASP." 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 (e.g., chemo SC admin code 96401 vs. therapeutic SC 96372), we surface the conflict rather than picking a side.