Summary & Overview
HCPCS Q5114: Trastuzumab-dkst (Ogivri) Injection, 10 mg
HCPCS Level II code Q5114 identifies the biosimilar trastuzumab-dkst (Ogivri) in a 10 mg unit for injectable administration. This code is used when billing for the specific trastuzumab biosimilar product rather than the reference biologic, and it matters nationally because trastuzumab biosimilars are integral to breast and gastric cancer therapy regimens and to payer efforts to manage biologic drug costs. The code facilitates tracking of biosimilar utilization and supports reimbursement for outpatient infusion services.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for payer coverage and common billing practices, a concise clinical context describing the therapeutic role of trastuzumab biosimilars, and relevant coding considerations such as appropriate unit reporting for drug billing. The summary also highlights where input is limited: specific payer policies, utilization data, and associated ICD-10 diagnoses are not available in the input.
This publication is intended for a national audience of billing managers, oncology clinic administrators, and policy analysts seeking a clear description of HCPCS Level II code Q5114, its clinical use, and the payer landscape relevant to biosimilar trastuzumab in outpatient infusion settings.
Billing Code Overview
HCPCS Level II code Q5114 represents an injection product: trastuzumab-dkst, biosimilar (Ogivri), 10 mg. This code describes the billed item as a biosimilar formulation of trastuzumab provided as an injectable oncology agent.
Service Type: Therapeutic injection / oncology biologic administration
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or clinic-based infusion setting
Clinical & Coding Specifications
Clinical Context
A patient with HER2-positive breast cancer receives therapeutic intravenous biosimilar trastuzumab-dkst (Q5114) as part of systemic anti-cancer therapy. Typical patients are adults undergoing adjuvant, neoadjuvant, or metastatic treatment for HER2-expressing breast carcinoma. The clinical workflow: oncologist documents HER2-positive diagnosis and treatment plan; pharmacy prepares dose based on body weight or BSA using the 10 mg vial concentration; infusion nurse verifies orders, obtains informed consent, performs baseline vitals and cardiac assessment (e.g., recent ECHO or MUGA), establishes IV access, and administers the infusion per institutional protocol with vital sign monitoring during and after infusion. Post-infusion documentation includes administered dose (vial count and total mg), lot number, route (intravenous), any premedications or infusional reactions, and applicable modifier(s) for billing (e.g., billing for drug only or with service-level modifiers). Typical site of service is an oncology infusion center, hospital outpatient infusion department, or ambulatory infusion clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | When partial vial unused is discarded and payer requires reporting of wasted biologic drug |