HCPCS Code Q5114: Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg

Q5114 is used to report injection of trastuzumab-dkst, a biosimilar (Ogivri), 10 mg. It allows payers and providers to differentiate between the biosimilar and the reference product Herceptin® (J9355).

Report 1 unit per 10 mg of trastuzumab-dkst administered. For example, if a patient receives 150 mg, bill 15 units of Q5114.

While Medicare Part B generally provides coverage for trastuzumab-dkst (Q5114) when used for FDA-approved indications or recognized compendia-supported off-label uses, payer requirements can differ widely. Medicare Advantage plans and most commercial insurers often require prior authorization or step therapy before approving coverage for trastuzumab biosimilars. Providers are strongly advised to verify individual payer policies and obtain necessary approvals before administration and billing to prevent claim denials.

Yes. Medicare covers trastuzumab-dkst when used for FDA-approved indications or compendia-supported off-label uses. Documentation of diagnosis, dose, and medical necessity must be included in the claim.