Q5135 HCPCS code: Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg
Q5135 is the HCPCS Level II code for injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg. In 2024 Medicare paid an average of $3.92 per service for Q5135 across 91,772 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 1200 per day on DME suppliers. In 2024, about 74 clinicians billed Medicare for Q5135 for 114 beneficiaries; Utah, California, Florida accounted for 83% 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 | 2024-10-01 |
| Last action effective | 2024-10-01 |
Who bills Q5135 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 74 |
| Medicare beneficiaries | 114 |
| States with claims | 5 |
| Share of services in top 3 states (Utah, California, Florida) | 83% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q5135, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 91,772 | 114 | $4.92 | $3.92 |
States with the most Q5135 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Utah | 27,558 | $4.00 |
| California | 15,654 | $3.72 |
| Florida | 14,160 | $3.95 |
| Minnesota | 6,760 | $3.86 |
| Arizona | 4,720 | $3.96 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1200 | Prescribing Information |
| outpatient hospital claims | 1200 | Prescribing Information |
| practitioner claims | 1200 | Prescribing Information |
What changed for Q5135
- 2024-10-01: Q5135 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 Q5135?
Q5135 is the HCPCS Level II code for injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg. Short descriptor: "Inj, tyenne, 1 mg".
How much does Medicare pay for Q5135?
In 2024, the average Medicare payment was $3.92 per service (average allowed $4.92).
Does Medicare cover Q5135?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of Q5135 can be billed per day?
1200 on DME suppliers; 1200 on outpatient hospital claims; 1200 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 Q5135
- Watch Q5135 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q5135
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.