HCPCS Q5104 (Renflexis) Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Anti-Inflammatory Medication and Chemotherapy Medication |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for Q5104 |
| Medicare Payment Limit | $26.999  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 00006-4305-02 - RENFLEXIS (PF,LYOPHILIZED) 100 MG • 78206-0162-01 - RENFLEXIS (PF,LYOPHILIZED) 100 MG |
National average reimbursement for HCPCS Q5104 by major payers:
$30.87
$30.54
$33.79
$30.08
HCPCS Q5104 vs. Other Anti-Inflammatory Medication and Chemotherapy Medication Codes
The HCPCS Q5104 code is part of the Temporary Codes services used for Anti-Inflammatory Medication and Chemotherapy Medication. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS Q5104 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 00006-4305-02-NDC | Moderate | RENFLEXIS (PF,LYOPHILIZED) 100 MG |
| 78206-0162-01-NDC | Moderate | RENFLEXIS (PF,LYOPHILIZED) 100 MG |
| Q5103-HCPCS | Low | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
| Q5104-HCPCS | Low | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q5104. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the Q5104 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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