Q5104 — Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

Medicare coverage: Special coverage instructions apply

There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.

From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.

Physician fee schedule statusE

Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).

Global period: XXX

Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.

Medically Unlikely Edits — units per day

The most units of Q5104 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.

practitioner

150 units

MAI 3 — Date of Service Edit: Clinical · Prescribing Information

outpatient

150 units

MAI 3 — Date of Service Edit: Clinical · Prescribing Information

DME supplier

0 — never payable

MAI 3 — Date of Service Edit: Clinical · CMS Policy

The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.