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    v1.0.30
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5138-iv-ustekinumab-auub-wezlana-1mg-biosimilar
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    HCPCS Level II Q5138: Ustekinumab-auub (Wezlana) IV Injection, 1 mg

    HCPCS Level II code Q5138 describes an intravenous injection of ustekinumab-auub (Wezlana) supplied as a biosimilar, billed per 1 mg unit; this represents an infused biologic medication administration typically provided in infusion centers or hospital outpatient departments for conditions treated with intravenous ustekinumab formulations and is coded for the drug product rather than the administration procedure.

    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 46-year-old patient with moderate-to-severe plaque psoriasis refractory to topical therapy and phototherapy presents for intravenous induction dosing of a biosimilar ustekinumab product, Q5138 (wezlana), administered as an inpatient-observed or hospital outpatient infusion or in an infusion center. The clinical workflow begins with verification of the biologic order and insurance benefits, pre-infusion screening for active infection and tuberculosis, and baseline labs (CBC, CMP). The infusion visit includes patient identity confirmation, informed consent for intravenous biologic therapy, medication preparation and labeling by pharmacy, intravenous access placement, administration of the weight‑based Q5138 dose over the prescribed infusion time, and monitoring for infusion reactions for at least 30–60 minutes post‑infusion. Documentation includes indication, dose (mg), lot number, route intravenous, start/stop times, vital signs, any adverse events, and medication disposal records for wasted product. Follow-up scheduling for maintenance dosing and dermatology or rheumatology clinic coordination completes the workflow.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hourUsed for documentation and billing of the infusion administration time when Q5138 is given IV and requires an infusion service of up to 1 hour.
    96366Intravenous infusion, each additional hour (List separately in addition to code for primary infusion)Used if the infusion duration for Q5138 extends beyond the initial hour and additional infusion time is billed.
    96374Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, each additional drugUsed for IV push administration techniques when applicable, although Q5138 is typically infused rather than pushed.
    36415Collection of venous blood by venipuncturePerformed for baseline or post‑infusion labs required before or after administration of Q5138.
    36556Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or olderUsed if central access is required for delivery of IV biologic in patients with poor peripheral access.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    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…
    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…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    207L00000X
    364S00000X
    363LA2200X
    2085R0205X
    207RE0101X
    2084B0002X
    243U00000X

    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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