HCPCS drug code for Truxima, a rituximab biosimilar given by IV infusion, billed per 10 mg.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Product name (Truxima) and NDC matching the claim
- Dose in mg and units billed
- Infusion start and stop times
- Discarded amount if any
- Diagnosis supporting rituximab
- Last infusion date in pre-op notes
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Q5115 reports Truxima (rituximab-abbs) per 10 mg. It is a biosimilar to IV rituximab and is used for the same oncology and rheumatology indications. Many payers now list a rituximab biosimilar as preferred, so Q5115 may be the code you see more than J9312.
Unit math is the same as the reference product: a 1,000 mg rheumatology dose is 100 units. Do not bill a biosimilar dose under J9312, and do not bill Truxima under another biosimilar's Q code. The NDC on the claim should match the product given, and payers check.
For orthopedic practices, the clinical story is the same as rituximab. Rheumatoid patients on Truxima have months of B-cell depletion, and elective surgery is usually timed toward the end of the dosing cycle. Record the last infusion date in the pre-op note. If your group infuses it, bill the infusion admin with times, and add JW or JZ for the single-dose vials.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
HOPD (APC 9336) Hospital outpatient department | $30.15 |
Common denial reasons
The recurring reasons claims for CPT Q5115 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- NDC on claim does not match Q5115
- Billed under J9312 instead of the biosimilar code
- Payer prefers a different biosimilar
- Units billed per vial instead of per 10 mg
- Missing JW or JZ modifier
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What drug is Q5115?
02How many units of Q5115 for a 1,000 mg infusion?
03Can Truxima be billed with J9312?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Medicare Part B Drug Average Sales Price files
- 03cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe notes record which rituximab product the patient receives and when, so pre-op timing and the claim both reflect the right drug.
See how Mira captures CPT Q5115 documentation