Q5121 HCPCS code: Injection, infliximab-axxq, biosimilar, (avsola), 10 mg
Q5121 is the HCPCS Level II code for injection, infliximab-axxq, biosimilar, (avsola), 10 mg. In 2024 Medicare paid an average of $17.13 per service for Q5121 across 204,994 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 150 per day on outpatient hospital claims. Medicare volume fell 11% from 2022 to 2024 (230,240 to 204,994 services). In 2024, about 1,007 clinicians billed Medicare for Q5121 for 1,128 beneficiaries; Minnesota, North Carolina, Maryland 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 | 2020-07-01 |
| Last action effective | 2023-10-01 |
Who bills Q5121 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,007 |
| Medicare beneficiaries | 1,128 |
| States with claims | 26 |
| Share of services in top 3 states (Minnesota, North Carolina, Maryland) | 42% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5121, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 230,240 | 1,134 | $38.58 | $30.66 |
| 2023 | 316,705 | 1,536 | $26.94 | $21.32 |
| 2024 | 204,994 | 1,128 | $21.75 | $17.13 |
States with the most Q5121 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Minnesota | 36,713 | $17.77 |
| North Carolina | 23,335 | $17.09 |
| Maryland | 19,881 | $17.50 |
| Colorado | 15,899 | $18.12 |
| Arizona | 10,951 | $18.14 |
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
- A52423: Billing and Coding: Infliximab and biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A56432: Billing and Coding: Infliximab (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (692 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D86.0 | Sarcoidosis of lung | 2 |
| D86.1 | Sarcoidosis of lymph nodes | 2 |
| D86.2 | Sarcoidosis of lung with sarcoidosis of lymph nodes | 2 |
| D86.3 | Sarcoidosis of skin | 2 |
| D86.81 | Sarcoid meningitis | 2 |
| D86.82 | Multiple cranial nerve palsies in sarcoidosis | 2 |
| D86.83 | Sarcoid iridocyclitis | 2 |
| D86.84 | Sarcoid pyelonephritis | 2 |
| D86.85 | Sarcoid myocarditis | 2 |
| D86.86 | Sarcoid arthropathy | 2 |
Showing 10 of 692. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q5121
- 2020-07-01: Q5121 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 Q5121?
Q5121 is the HCPCS Level II code for injection, infliximab-axxq, biosimilar, (avsola), 10 mg. Short descriptor: "Inj. avsola, 10 mg".
How much does Medicare pay for Q5121?
In 2024, the average Medicare payment was $17.13 per service (average allowed $21.75).
Does Medicare cover Q5121?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for Q5121?
Medicare policy articles that cite Q5121 list 692 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include D86.0 (Sarcoidosis of lung), D86.1 (Sarcoidosis of lymph nodes), D86.2 (Sarcoidosis of lung with sarcoidosis of lymph nodes). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q5121 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 Q5121
- Watch Q5121 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5121
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.