HCPCS Code Details - Q5104

HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q5104
Description

Long description:
Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

Short description:
Injection, renflexis

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Apr 01, 2018 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Apr 01, 2018
Date added Added Apr 01, 2018
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - Q5104

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
Jul 1, 2024 - Sep 30, 2024 10 MG 29.911 - - - - - -
April 1, 2024 - June 30, 2024 10 MG 30.579 - - - - - -
January 1, 2024 - March 31, 2024 10 MG 31.499 - - - - - -
October 1, 2023 - December 31, 2023 10 MG 32.562 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 10 MG 35.547 20% - - - - -

See also

  • HCPCS Q5103 · Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg

  • HCPCS Q5105 · Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”