How much does Medicare pay for HCPCS Q5121?

Medicare allowed an average of $23.34 per service and paid $18.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $97.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code Q5121?

Injection, infliximab-axxq, biosimilar, (avsola), 10 mg. It was billed 25,887 times to 255 Medicare beneficiaries by 17 providers in 2024.

Which specialty bills Q5121 most?

Nurse Practitioner, with 11,463 services from 8 clinicians. Next are Rheumatology, Physician Assistant, Internal Medicine.

HCPCS Q5121

Injection, infliximab-axxq, biosimilar, (avsola), 10 mg

$23.34Medicare-allowed amount per service, averaged across 25,887 services

Providers submitted

$97.21

Asking price, not received

Medicare allowed

$23.34

The fee schedule figure

Medicare paid

$18.41

Balance is patient coinsurance

Providers submitted an average of $97.21 for this code and Medicare allowed $23.34 — 4.2× 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 $18.41 (79%); the rest is the patient’s coinsurance and deductible.

Services: 25,887
Beneficiaries: 255
Providers billing it: 17
Total allowed: $604,203

What Medicare pays for HCPCS Q5121

Across 25,887 services billed by 17 providers to 255 beneficiaries, Medicare allowed an average of $23.34 per service. That is 101.5 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 Q5121

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	11,463	126	$24.27	8
Rheumatology	7,174	51	$22.85	3
Physician Assistant	4,686	42	$22.36	3
Internal Medicine	970	14	$20.97	1
Hematology	814	11	$22.35	1
Endocrinology	780	11	$24.03	1

Q5121 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	12,833	$24.38	$19.34	9
Colorado	5,414	$22.56	$17.84	1
Arizona	2,530	$23.43	$18.53	3
North Carolina	2,380	$20.08	$18.24	1
Arkansas	1,260	$23.24	$19.65	1
Michigan	970	$20.97	$16.71	1
California	500	$25.08	$18.41	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
Q5104Injection, infliximab-abda, biosimilar, (renflexis), 10 mg$29.21
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

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.