Q5113 HCPCS code: Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg
Q5113 is the HCPCS Level II code for injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg. In 2023 Medicare paid an average of $23.24 per service for Q5113 across 7,174 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 120 per day on outpatient hospital claims. Medicare volume rose 43% from 2022 to 2023 (5,027 to 7,174 services). In 2023, about 28 clinicians billed Medicare for Q5113 for 23 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2019-07-01 |
| Last action effective | 2023-10-01 |
Who bills Q5113 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 28 |
| Medicare beneficiaries | 23 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5113, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,027 | 22 | $48.40 | $38.51 |
| 2023 | 7,174 | 23 | $29.18 | $23.24 |
States with the most Q5113 services (2023)
| State | Services | Avg. paid |
|---|---|---|
| Wisconsin | 6,364 | $22.96 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 120 | Clinical: Society Comment |
| practitioner claims | 120 | Clinical: Society Comment |
What changed for Q5113
- 2019-07-01: Q5113 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q5113?
Q5113 is the HCPCS Level II code for injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg. Short descriptor: "Inj herzuma 10 mg".
How much does Medicare pay for Q5113?
In 2023, the average Medicare payment was $23.24 per service (average allowed $29.18).
Does Medicare cover Q5113?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of Q5113 can be billed per day?
120 on outpatient hospital claims; 120 on practitioner claims (NCCI medically unlikely edits).
Related Q51 codes
- Q5100 — Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5101 — Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
- Q5102 — Injection, infliximab, biosimilar, 10 mg
- Q5103 — Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
- Q5104 — Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
- Q5105 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units
- Q5106 — Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
- Q5107 — Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg
- Q5108 — Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
- Q5109 — Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg
- Q5110 — Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111 — Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
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Next steps
- Run a reimbursement report for a device billed under Q5113
- Watch Q5113 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5113
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.