Question 1

What is HCPCS code Q5137?

Accepted Answer

HCPCS code Q5137 is "Inj, wezlana, sub cu, 1 mg". Injection, ustekinumab-auub (wezlana), biosimilar, subcutaneous, 1 mg

Question 2

What category is Q5137 in?

Accepted Answer

Q5137 belongs to HCPCS Category Q (Temporary Codes).

Question 3

When should I use HCPCS code Q5137?

Accepted Answer

Use Q5137 when billing for inj, wezlana, sub cu, 1 mg. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is Q5137 covered by Medicare?

Accepted Answer

Coverage for Q5137 (Inj, wezlana, sub cu, 1 mg) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for Q5137?

Accepted Answer

Documentation for Q5137 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).