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    v1.0.30
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5104-infliximab-abda-renflexis-10mg-infusion
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    HCPCS Level II Q5104: Infliximab-abda (Renflexis) Injection, 10 mg

    HCPCS Level II code Q5104 describes an injection of infliximab-abda, a biosimilar to infliximab branded as Renflexis, supplied in a 10 mg unit; this code is used to report the biologic infusion/administration product for infusion therapies, typically administered in infusion centers or outpatient hospital/clinic settings for conditions treated with infliximab products.

    For related coverage guidance, see recent payer policy updates: Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatment, HIV/AIDS Pharmacologic Prevention and Treatment, Long-Acting Injectable Antiretroviral Agents for HIV.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient receiving Q5104 is an adult with an immune-mediated inflammatory disease such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn disease, or ulcerative colitis who requires maintenance intravenous biologic therapy with an infliximab biosimilar (renflexis). The clinical workflow begins with a physician visit by a rheumatologist, gastroenterologist, or infusion center medical director who documents indication, prior response to therapy, weight-based dosing calculation, and screening for active infections (including tuberculosis and hepatitis B). Prior authorization is frequently obtained from payors including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthCare, BUCA, or Medicare. On the infusion day the patient is triaged, vital signs recorded, premedication ordered as needed (acetaminophen, antihistamine, corticosteroid), and an intravenous line placed by a registered nurse. The Q5104 drug vial is prepared by pharmacy, delivered to the infusion suite, administered per product-specific infusion rate with monitoring for infusion reactions, and post-infusion observation is performed. Documentation includes medication name infliximab-abda (renflexis), NDC and lot number, dose in mg, infusion start and stop times, patient tolerance, and any concurrent administration codes or modifiers (for example reporting wasted drug using JW when applicable). Billing is submitted to the patient’s primary insurer with the appropriate HCPCS code Q5104, diagnosis code(s) supporting medical necessity, and relevant modifiers for payment circumstances or administration complexities.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugCommonly used for administration time-based billing of complex biologic IV infusions when applicable to payer guidance
    96415Chemotherapy administration, each additional hourUsed when infusion time exceeds the first hour and payer allows chemotherapy infusion codes for biologics
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourAlternate infusion administration code used by some facilities for non-chemotherapy biologic infusions depending on payer rules
    96366Intravenous infusion, each additional hourUsed when infusion extends beyond the initial hour for non-chemotherapy biologics
    36415Collection of venous blood by venipuncturePerformed for necessary pre-infusion lab monitoring, e.g., CBC, CMP, or drug level testing

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    208D00000X
    363L00000X
    222Z00000X
    133NN1002X
    1223P0700X
    175L00000X
    2471B0102X

    Related ICD-10-CM Codes

    20 rows

    ICD-10-CM CodeDescription
    D86.9Sarcoidosis, unspecified
    I83.90Asymptomatic varicose veins of unspecified lower extremity
    J45.909Unspecified asthma, uncomplicated
    K50.90Crohn's disease, unspecified, without complications
    K51.90Ulcerative colitis, unspecified, without complications
    L40.0Psoriasis vulgaris
    L40.9Psoriasis, unspecified
    M05.79Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
    M05.89Other rheumatoid arthritis with rheumatoid factor of multiple sites
    M06.4Inflammatory polyarthropathy

    Showing 1–10 of 20

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) for HIV Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    HIV/AIDS Pharmacologic Prevention and Treatmentpremerabluecrossofwashington2026-10-01
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

    HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

    HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

    HCPCS Level II Q5132: Injection, adalimumab-afzb (Abrilada), 10 mg

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

    HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

    HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

    HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

    HCPCS Q0085: Chemotherapy Infusion Plus Other Technique(s), Per Visit

    HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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