Q5115 HCPCS code: Injection, rituximab-abbs, biosimilar, (truxima), 10 mg
Q5115 is the HCPCS Level II code for injection, rituximab-abbs, biosimilar, (truxima), 10 mg. In 2024 Medicare paid an average of $25.43 per service for Q5115 across 692,854 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 150 per day on outpatient hospital claims. Medicare volume fell 27% from 2022 to 2024 (946,349 to 692,854 services). In 2024, about 1,557 clinicians billed Medicare for Q5115 for 2,873 beneficiaries; California, Maryland, Minnesota accounted for 22% of services.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2019-07-01 |
| Last action effective | 2019-07-01 |
Who bills Q5115 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,557 |
| Medicare beneficiaries | 2,873 |
| States with claims | 39 |
| Share of services in top 3 states (California, Maryland, Minnesota) | 22% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5115, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 946,349 | 3,658 | $51.63 | $41.21 |
| 2023 | 914,447 | 3,579 | $42.16 | $33.57 |
| 2024 | 692,854 | 2,873 | $31.94 | $25.43 |
States with the most Q5115 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 57,472 | $25.12 |
| Maryland | 46,422 | $25.59 |
| Minnesota | 45,710 | $25.82 |
| Arizona | 41,250 | $25.47 |
| Texas | 40,510 | $25.08 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
Medicare policy articles for this code
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B))
- A58582: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59101: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,184 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D59.0 | Drug-induced autoimmune hemolytic anemia | 4 |
| D59.11 | Warm autoimmune hemolytic anemia | 4 |
| D59.12 | Cold autoimmune hemolytic anemia | 4 |
| D59.13 | Mixed type autoimmune hemolytic anemia | 4 |
| D69.3 | Immune thrombocytopenic purpura | 4 |
| D69.41 | Evans syndrome | 4 |
| D89.811 | Chronic graft-versus-host disease | 4 |
| G35.A | Relapsing-remitting multiple sclerosis | 4 |
| G36.0 | Neuromyelitis optica [Devic] | 4 |
| G70.00 | Myasthenia gravis without (acute) exacerbation | 4 |
Showing 10 of 1,184. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5115
- 2019-07-01: Q5115 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 Q5115?
Q5115 is the HCPCS Level II code for injection, rituximab-abbs, biosimilar, (truxima), 10 mg. Short descriptor: "Inj truxima 10 mg".
How much does Medicare pay for Q5115?
In 2024, the average Medicare payment was $25.43 per service (average allowed $31.94).
Does Medicare cover Q5115?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q5115?
Medicare policy articles that cite Q5115 list 1,184 covered ICD-10-CM diagnosis codes across 4 articles. The most cited include D59.0 (Drug-induced autoimmune hemolytic anemia), D59.11 (Warm autoimmune hemolytic anemia), D59.12 (Cold autoimmune hemolytic anemia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5115 can be billed per day?
150 on outpatient hospital claims; 150 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 Q5115
- Watch Q5115 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5115
Sources: CMS HCPCS Level II release October 2026; 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.