Summary & Overview
HCPCS Q5117: Trastuzumab-anns (Kanjinti) Injection, 10 mg
HCPCS Level II code Q5117 designates a 10 mg unit of trastuzumab-anns, the biosimilar sold as Kanjinti, used for parenteral administration in oncology. This drug-level code is essential for accurate drug billing, inventory tracking, and payment for biologic therapies nationally, especially as biosimilars play an increasing role in cost-containment and access to monoclonal antibody treatments. Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what Q5117 represents clinically and operationally, followed by benchmarking context and payer coverage considerations. The publication covers pricing and reimbursement benchmarks where available, typical sites of service for administration, and policy updates that affect biosimilar billing and coding. Clinical context on trastuzumab biosimilars, including common use cases and implications for infusion services, is also provided. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code Q5117 represents an injection of trastuzumab-anns, a biosimilar branded as Kanjinti, dosed per 10 mg units. The code denotes the drug product for infusion or injection used in oncology indications where trastuzumab therapy is appropriate.
Service Type: Therapeutic drug administration (trastuzumab biosimilar)
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or clinic-based infusion suite
Clinical & Coding Specifications
Clinical Context
A typical patient is a 52-year-old woman with HER2-positive invasive breast carcinoma receiving intravenous biosimilar trastuzumab (Q5117) as part of adjuvant or metastatic systemic therapy. The therapy is ordered by a medical oncologist and administered in an outpatient infusion center or hospital outpatient department. Prior to infusion, the patient undergoes baseline assessment including vitals, weight-based dose calculation, review of prior cardiac function (echocardiogram or MUGA) and medication reconciliation. An IV or implanted port is accessed, premedication is given as indicated, and the Q5117 dose is prepared by pharmacy in a sterile compounding area. During infusion, nursing documents infusion start/stop times, vital sign trends, and any infusion reactions. Post-infusion, the patient is observed per institutional protocol for delayed reactions and scheduled for subsequent cycles, cardiac monitoring, and oncology follow-up. Typical site of service: outpatient infusion center, physician office infusion suite, or hospital outpatient department. Service type: oncology biologic infusion (intravenous monoclonal antibody therapy).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Discarded drug amount | When part of a single-use vial biologic is wasted and payer requires reporting discarded portion |