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See a sample rate comparisonHCPCS Q5116 (Trazimera) Fee Schedule
Last Verified: October 2026
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.
Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
| Key Fact | Detail |
|---|---|
| Service Type | Temporary Codes Cancer, Vision and Other Associated Drugs |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for Q5116 |
| Medicare Payment Limit | $27.991  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS Q5116 by major payers:
$21.04
$24.12
$25.30
$21.50
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HCPCS Q5116
5 of 25 sample ratesHigher to lower in this preview
Yetunde Daniel
Aria Health Physician Services
$25.61Published rateKarl Chen
Karl T Chen LLC
$20.04Published rateSilvia Wang
Kennedy Medical Group Practice PC
$18.96Published rateMaher Badri
Ridgefield Medical Services LLC
$14.06Published rateMichael Ellis
Keep Glowing Medical Spa LLC
$10.10Published rate
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See a sample payer proposalHCPCS Q5116 vs. Other Cancer, Vision and Other Associated Drugs Codes
The HCPCS Q5116 code is part of the Temporary Codes services used for Cancer, Vision and Other 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.
| Code | Complexity | Description |
|---|---|---|
| Q5115-HCPCS | Low | Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg |
| Q5116-HCPCS | Low | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg |
| Q5117-HCPCS | Low | Injection, trastuzumab-anns, biosimilar, (kanjinti), 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 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.
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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