Q5116 HCPCS code: Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
Q5116 is the HCPCS Level II code for injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg. In 2024 Medicare paid an average of $11.61 per service for Q5116 across 569,710 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 fell 10% from 2022 to 2024 (632,879 to 569,710 services). In 2024, about 1,805 clinicians billed Medicare for Q5116 for 1,974 beneficiaries; Texas, California, Virginia accounted for 42% of services.
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 | 2019-10-01 |
| Last action effective | 2019-10-01 |
Who bills Q5116 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,805 |
| Medicare beneficiaries | 1,974 |
| States with claims | 32 |
| Share of services in top 3 states (Texas, California, Virginia) | 42% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5116, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 632,879 | 2,136 | $47.20 | $37.69 |
| 2023 | 877,846 | 2,901 | $24.65 | $19.62 |
| 2024 | 569,710 | 1,974 | $14.66 | $11.61 |
States with the most Q5116 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 116,204 | $11.71 |
| California | 68,176 | $11.44 |
| Virginia | 47,304 | $11.60 |
| Florida | 41,104 | $11.54 |
| Illinois | 30,940 | $11.69 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 120 | Prescribing Information |
| practitioner claims | 120 | Prescribing Information |
What changed for Q5116
- 2019-10-01: Q5116 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 Q5116?
Q5116 is the HCPCS Level II code for injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg. Short descriptor: "Inj., trazimera, 10 mg".
How much does Medicare pay for Q5116?
In 2024, the average Medicare payment was $11.61 per service (average allowed $14.66).
Does Medicare cover Q5116?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of Q5116 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q5116
- Watch Q5116 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5116
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.