How much does Medicare pay for HCPCS Q5104?

Medicare allowed an average of $29.21 per service and paid $23.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $129.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q5104?

Injection, infliximab-abda, biosimilar, (renflexis), 10 mg. It was billed 317,132 times to 2,215 Medicare beneficiaries by 122 providers in 2024.

Which specialty bills Q5104 most?

Rheumatology, with 217,837 services from 81 clinicians. Next are Internal Medicine, Physician Assistant, Nurse Practitioner.

HCPCS Q5104

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

$29.21Medicare-allowed amount per service, averaged across 317,132 services

Providers submitted

$129.21

Asking price, not received

Medicare allowed

$29.21

The fee schedule figure

Medicare paid

$23.07

Balance is patient coinsurance

Providers submitted an average of $129.21 for this code and Medicare allowed $29.21 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $23.07 (79%); the rest is the patient’s coinsurance and deductible.

Services: 317,132
Beneficiaries: 2,215
Providers billing it: 122
Total allowed: $9,263,426

What Medicare pays for HCPCS Q5104

Across 317,132 services billed by 122 providers to 2,215 beneficiaries, Medicare allowed an average of $29.21 per service. That is 143.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills Q5104

Specialty	Services	Beneficiaries	Avg allowed	Providers
Rheumatology	217,837	1,377	$29.24	81
Internal Medicine	25,120	156	$29.01	7
Physician Assistant	19,165	179	$29.35	6
Nurse Practitioner	17,824	148	$28.80	10
Infectious Disease	13,405	153	$29.55	5
Physical Medicine and Rehabilitation	10,110	74	$29.19	4
Hematology-Oncology	10,091	75	$29.08	5
Gastroenterology	2,720	39	$29.07	3
Medical Oncology	860	14	$29.37	1

Q5104 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Minnesota	38,270	$29.11	$23.09	22
South Carolina	25,917	$29.46	$23.21	8
Arkansas	23,652	$29.50	$23.45	5
Michigan	18,940	$29.00	$23.39	8
Utah	18,440	$28.30	$22.56	5
Texas	16,650	$29.34	$23.40	5
Wisconsin	16,144	$29.54	$23.42	7
Colorado	15,900	$29.33	$23.20	7
North Carolina	15,830	$29.33	$23.12	4
Maryland	15,560	$29.39	$23.23	6
Washington	11,400	$29.17	$23.15	5
Iowa	11,400	$28.70	$23.30	6
California	10,288	$28.43	$22.41	6
Idaho	9,756	$28.29	$22.46	2
Arizona	9,675	$29.43	$23.30	3
Oregon	8,974	$29.40	$23.24	3
Nevada	6,270	$29.50	$22.96	2
Georgia	5,970	$29.17	$23.14	2
Delaware	5,760	$29.39	$23.05	1
Massachusetts	4,641	$29.60	$23.12	2
North Dakota	4,273	$29.37	$23.34	2
Louisiana	4,070	$29.59	$23.58	1
Florida	4,004	$29.08	$23.03	2
Kansas	3,860	$29.57	$23.47	1
New Mexico	3,850	$29.54	$23.64	2
Rhode Island	3,003	$29.37	$23.38	1
Indiana	1,500	$30.79	$23.59	1
Virginia	1,450	$30.05	$23.89	1
Alabama	955	$31.02	$23.56	1
Illinois	730	$31.02	$23.52	1

Related codes

Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram$0.27
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram$0.48
Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram$0.32
Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use$7.27
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg$227.58
Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mg$39.68
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg$63.66
Q5119Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg$20.05
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg$57.38
Q5107Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg$25.75
Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg$169.39
Q5118Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg$20.91

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.