HCPCS code Q5113: Herzuma injection, per 10 mg2026 Medicare rate & RVUs in Washington
Q5113 reports trastuzumab-pkrb (Herzuma) in 10 mg units when this biosimilar is administered as part of HER2-positive cancer treatment.
CMS doesn’t publish an office rate for Q5113 in Washington.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What Q5113 covers
Q5113 identifies trastuzumab-pkrb, the biosimilar marketed as Herzuma. It is used in oncology treatment for HER2-positive breast and gastric cancers and is administered by intravenous infusion. Oncology clinicians report the drug code for the product administered. The code identifies the drug product, not the infusion service; a separately reportable administration service may be coded when appropriate. Use the product-specific code matching the drug administered, rather than another trastuzumab biosimilar code.
Each unit represents 10 mg of trastuzumab-pkrb, so the unit count is based on the total dose administered in 10 mg increments. CMS assigns status E, excluding Q5113 from the physician fee schedule. When Medicare covers the drug, it is a Part B drug generally paid using CMS quarterly Average Sales Price drug pricing files; coverage is left to the Medicare contractor's judgment.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where Q5113 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | Unavailable | Unavailable |
| Rest of Washington | Unavailable | Unavailable |
How the Q5113 rate is calculated
Each of Q5113’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · Q5113
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for Q5113
Q5113 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · Q5113
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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Q5113 isn’t priced in this setting.
Q5113 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- Q5112Ontruzant injectionPer 10 mg
- Q5112 identifies Ontruzant, not Herzuma. Select the code that matches the trastuzumab product administered.
- Q5114Ogivri injectionPer 10 mg
- Q5114 identifies Ogivri. Q5113 is specific to Herzuma; the products use separate HCPCS codes.
- J9355Trastuzumab injectionPer 10 mg, non-biosimilar
- J9355 identifies trastuzumab rather than trastuzumab-pkrb (Herzuma). Use Q5113 when the administered product is Herzuma.
Q5113 billing questions
How is Q5113 different from other trastuzumab biosimilar codes?
Q5113 identifies trastuzumab-pkrb (Herzuma). Use the product-specific code matching the trastuzumab product administered; Q5112, Q5114, Q5116, and Q5117 identify other products.
How many units should be reported?
Report one unit for each 10 mg administered. Base the unit count on the documented dose.
Does Q5113 include the infusion administration?
Q5113 identifies the drug, not the infusion service. Report an administration service separately when appropriate.
How does Medicare treat Q5113?
CMS excludes it from the physician fee schedule under status E. When covered, it is a Part B drug generally paid using CMS quarterly ASP drug pricing files, and the Medicare contractor determines coverage.
What documentation supports the units?
Document the product administered and the total dose. The reported units should reflect the dose in 10 mg increments.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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