HCPCS Code Q5115: Injection, Rituximab-Abbs, Biosimilar, (Truxima), 10 mg

Learn about HCPCS Code Q5115 for Rituximab-Abbs (Truxima), a biosimilar injection used to treat CD20-positive B-cell malignancies and autoimmune disorders.

Use Code

## **What is this service?** HCPCS Code Q5115 refers to the injection of Rituximab-Abbs, a biosimilar known by the brand name Truxima, administered in doses of 10 mg. This service involves the intravenous infusion of a monoclonal antibody that targets the CD20 antigen found on the surface of immature and mature B cells. The binding of this antibody to CD20 leads to the destruction of these B cells through immune-mediated mechanisms such as complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity. Rituximab-Abbs is primarily used in the treatment of CD20-positive B-cell malignancies, including follicular lymphoma grade II, follicular lymphoma grade III, diffuse large B-cell lymphoma, cutaneous follicle center lymphoma, unspecified B-cell lymphoma, and chronic lymphocytic leukemia. In addition to oncology, Rituximab-abbs is FDA-approved for autoimmune conditions such as rheumatoid arthritis. Other autoimmune uses (e.g., lupus) may be considered off-label and require payer-specific authorization. It is also indicated for certain autoimmune disorders, such as systemic lupus erythematosus, where it works by depleting harmful B cells implicated in these pathological immune responses. It is also used in cases of rapidly progressive nephritic syndrome that are caused by the underlying autoimmune disease, helping to control disease progression and symptoms. This targeted treatment is administered by healthcare professionals through intravenous infusion and is essential for managing active disease involving B-cell abnormalities.

## **Documentation requirements** To bill HCPCS Code Q5115 appropriately, documentation must include: - Evidence of diagnosis with an FDA-approved or medically accepted indication, such as diffuse large B-cell lymphoma, follicular lymphoma, CLL, or rheumatoid arthritis. - Detailed clinical findings including involvement of lymph nodes, intra abdominal lymph nodes, intrathoracic lymph nodes, and multiple sites of disease. - Notation of any central nervous system or lung involvement as part of the disease presentation. - Documentation of rheumatoid factor status when applicable to autoimmune or immune-mediated mechanisms. Include disease activity and prior therapy failure, rather than just rheumatoid factor status alone. - Confirmation of active disease requiring rituximab-abbs (Truxima) therapy. - Clinical evaluation supporting the necessity of treatment with rituximab biosimilar. - Record of patient’s clinical presentation and diagnosis supporting rituximab-abbs use, and record of immune mechanism or disorders involving immune dysfunction to justify treatment. - Identification of disease classification consistent with FDA-approved or medically accepted indications for rituximab. - Administration details, including intravenous infusion documentation by qualified healthcare professionals with appropriate medical support. - Monitoring and management of any infusion related reactions throughout treatment. **Note**: Documentation must confirm active disease requiring Rituximab therapy and disease subtype consistent with FDA approvals.

## **Billing requirements** Billing requirements for HCPCS Code Q5115 (Injection, rituximab-abbs, biosimilar, Truxima, 10 mg) include: - The provider must submit the correct HCPCS code Q5115 for the rituximab-abbs injection based on the dosage administered, with each billing unit representing 10 mg of the drug. - An appropriate ICD-10-CM diagnosis code must accompany the claim to justify medical necessity. Accepted diagnoses typically include non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma, follicular lymphoma, CLL) and rheumatoid arthritis. Rituximab-abbs is not indicated for Hodgkin lymphoma. - Claims should indicate the number of units administered correlating to the total milligram dosage. - The place of service and administration codes must be correctly reported to identify where and how the infusion was given. - The provider’s usual and customary charges should be billed, especially for non-340B drugs. - National Drug Code (NDC) numbers and appropriate NDC units should be included when required by the payer. - Providers must follow payer-specific requirements, which may include prior authorization or step therapy documentation for off-label uses. - Compliance with fee schedules and reimbursement rates as published by government and private payers is essential for accurate payment.

## **Other relevant codes** - **C82.00–C82.99**: Follicular lymphoma, Grades I–III, including diffuse follicle center lymphoma and cutaneous follicle center lymphoma - **C83.00–C83.09**: Small cell B-cell lymphoma - **C83.30–C83.39**: Diffuse large B-cell lymphoma, lymph nodes of various sites - **C83.80–C83.89**: Other non-follicular lymphoma, lymph nodes of specific sites

Frequently asked questions

Rituximab biosimilar treats CD20-positive B cell lymphomas including non-Hodgkin lymphoma and lymphoma unspecified, providing appropriate medical support.

Infusion related reactions can occur during intravenous push or induction infusion. Healthcare professionals provide medical support to manage these safely.

Lymph nodes including intrapelvic lymph nodes, as well as solid organ sites, influence treatment planning, requiring clinical evaluation during active disease and induction treatment.