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HCPCS Q5115 · Level II · Part B drug

HCPCS Q5115: Injection, rituximab-abbs, biosimilar, (truxima), 10 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for Q5115

Billing unit
10 MG
Inj truxima 10 mg
ASP payment limit
$35.988
October 2026; +4.1% vs July 2026
Practitioner MUE
150
MAI 3
OPPS status
SI K
APC 9336
NCCI exposure
no PTP pairs
Coverage articles
1
4 states

TL;DR

HCPCS Q5115 is the Level II code for Injection, rituximab-abbs, biosimilar, (truxima), 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $35.988 per billing unit, up 4.1% from July 2026. The practitioner MUE allows up to 150 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9336. As a biosimilar it has its own code and ASP; the reference product cannot be billed under this code, and the JZ or JW modifier rules for discarded amounts apply per single-dose vial. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 2 NDCs to it, sold as Truxima by Cephalon, LLC. 1 Medicare coverage article lists the code across 4 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q5115 at $35.988 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $34.563 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q5115
QuarterPayment limitPerCoinsurance
October 2026$35.98810 MG20%
July 2026$34.56310 MG—
CMS note: 8% of reference add-on applied

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 1 labeler to Q5115. Report the NDC in the claim's drug segment and bill the number of Q5115 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to Q5115
NDCDrug nameLabelerPackage sizeBilling units / package
63459-0103-10TruximaCephalon, LLC10 × 110
63459-0104-50TruximaCephalon, LLC50 × 150

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for Q5115. For practitioners the limit is 150 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for Q5115 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1503 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q5115 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

Q5115 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists Q5115 in their HCPCS tables, covering 4 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing Q5115
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Chemotherapy Agents for Non-Oncologic ConditionsWisconsin Physicians Service Insurance CorporationIA KS MO NEL37205

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q5115 carries status indicator K and is assigned to APC 9336, with a published national unadjusted payment of $34.56. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for Q5115 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks Q5115 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS Q5115

What does HCPCS code Q5115 describe?

Q5115 is defined by CMS as "Injection, rituximab-abbs, biosimilar, (truxima), 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q5115 in October 2026?

The ASP-based payment limit is $35.988 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $34.563.

How many units of Q5115 can be billed per day?

The practitioner Medically Unlikely Edit is 150 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to Q5115?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Truxima (Cephalon, LLC). For example NDC 63459-0103-10 is a 10 package equal to 10 billing units. The crosswalk's billing-units-per-package figure converts each package into Q5115 units.

Does Q5115 have NCCI bundling edits?

No active practitioner PTP pairs list Q5115 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention Q5115?

1 current Billing and Coding Article in the Medicare Coverage Database list Q5115, covering 4 states: (Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.