HCPCS Q5116 (Trazimera) Fee Schedule

HCPCS Q5116 vs. Other Cancer and Vision Associated Drugs Codes

The HCPCS Q5116 code is part of the Temporary Codes services used for Cancer and Vision Associated Drugs. 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 Q5116 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.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q5116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the Q5116 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.