HCPCS code Q5116: Trazimera, per 10 mg2026 Medicare rate & RVUs in Maine

CMS doesn’t publish an office rate for Q5116 in Maine.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What Q5116 covers

Trazimera is an intravenous trastuzumab biosimilar used in treatment regimens for HER2-positive breast cancer and certain gastric or gastroesophageal junction cancers. Oncology practices and hospital departments typically report the drug when they furnish it to a patient; Q5116 identifies the medication, not the infusion service. The medical record should support the product administered, dose, and clinical indication.

CMS assigns Q5116 physician fee schedule status E, so it is excluded from the physician fee schedule. When Medicare covers it, payment is under another method; as a Part B drug, it is generally paid using CMS quarterly ASP drug pricing files. Coverage is left to the Medicare contractor’s judgment. Each unit represents 10 mg of trastuzumab-qyyp, so units reflect the amount administered in 10 mg increments.

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 Q5116 pays more and less in Maine

How the Q5116 rate is calculated

Each of Q5116’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.

Payment rules and modifiers for Q5116

Q5116 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.

Q5116 compared with similar codes

How to choose

Q5112Ontruzant injectionPer 10 mg

Use Q5116 for Trazimera; Q5112 identifies Ontruzant. Both are trastuzumab biosimilar products, but the code follows the product administered.

Q5113Herzuma injectionPer 10 mg

Q5116 identifies Trazimera, while Q5113 identifies Herzuma. Select the code for the specific trastuzumab biosimilar given.

Q5114Ogivri injectionPer 10 mg

Q5116 is the Trazimera code; Q5114 identifies Ogivri. These codes distinguish products within the trastuzumab biosimilar group.

Q5117Kanjinti injectionPer 10 mg

Use Q5116 for Trazimera and Q5117 for Kanjinti. The product administered determines which code applies.

Codes related to Q5116

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates