Q5143 — Injection, adalimumab-adbm, biosimilar, 1 mg
Q5143 is a HCPCS Level II code for injection, adalimumab-adbm, biosimilar, 1 mg. It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 statusN
Non-covered service. Medicare does not cover it.
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 Q5143 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
- 160 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 160 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 160 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
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.
The CMS record for Q5143
- Long descriptor
- Injection, adalimumab-adbm, biosimilar, 1 mg
- Short descriptor
- Inj adalimumab-adbm, 1 mg
- Added
- January 1, 2025
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to Q5143
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q5143 is not quite right, the correct code is very often within a few positions of it.
- Q5135Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg
- Q5136Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg
- Q5137Injection, ustekinumab-auub (wezlana), biosimilar, subcutaneous, 1 mg
- Q5138Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg
- Q5139Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mgterminated
- Q5140Injection, adalimumab-fkjp, biosimilar, 1 mg
- Q5141Injection, adalimumab-aaty, biosimilar, 1 mg
- Q5142Injection, adalimumab-ryvk biosimilar, 1 mg
- Q5144Injection, adalimumab-aacf (idacio), biosimilar, 1 mg
- Q5145Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg
- Q5146Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg
- Q5147Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg
- Q5148Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram
- Q5149Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mg
- Q5150Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mg
- Q5151Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg
Questions about Q5143
What is HCPCS code Q5143?
Q5143 is a HCPCS Level II code for injection, adalimumab-adbm, biosimilar, 1 mg. It sits in the Temporary Codes section.
Does Medicare cover Q5143?
The CMS HCPCS file marks Q5143 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is Q5143 paid under the physician fee schedule?
Q5143 carries PFS status code N. Non-covered service. Medicare does not cover it.