HCPCS Code Q5119: Injection, Rituximab-pvvr, Biosimilar (Ruxience), 10 mg

Nail Q5119 billing for Ruxience. See clear rules for units, documentation, modifiers, and related codes to keep rituximab claims clean.

Use Code

## **What is Rituximab-pvvr?** HCPCS code Q5119 describes injection, rituximab-pvvr, biosimilar, (Ruxience), 10 mg. Rituximab-pvvr is a biosimilar to Rituxan that targets CD20 on B lymphocytes and is administered by intravenous infusion. It is used across oncology and rheumatology settings, including Non-Hodgkin lymphoma and chronic lymphocytic leukemia, and in autoimmune conditions such as rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis. The official long name in this code’s definition should appear in the chart and on the claim to confirm that the product is Ruxience and not another monoclonal. Oncology documentation often specifies detailed histology and sites. Examples include follicular lymphoma, diffuse large B-cell disease, mantle cell lymphoma, mediastinal thymic large B-cell disease, mucosa-associated lymphoid tissue (MALT lymphoma), Burkitt lymphoma, unspecified B-cell lymphoma, and Non-Hodgkin lymphoma of B-cell type with lymph nodes, lung involvement, central nervous system extension, or multiple sites. Records can also reference nodular lymphocyte predominant Hodgkin lymphoma and Lymphocyte-rich Hodgkin lymphoma when a broader diagnostic workup is being summarized. Some notes list disease groupings for completeness, such as large B-cell lymphoma, T-cell lymphoma, mature T- & NK-cell lymphoma, and Non-follicular diffuse lymphoma (unspecified) to show how the case fits into diseases classified as lymphoma. In rheumatology, charts may capture rheumatoid factor status, discuss disorders involving an immune mechanism, and address kidney risk in GPA or MPA, including rapidly progressive nephritic syndrome. Some payers consider compendia-supported uses such as immune thrombocytopenic purpura, but coverage depends on policy language. You may also evaluate rituximab for Systemic lupus erythematosus in select scenarios, although coverage is policy dependent.

## **Q5119 documentation requirements** Thorough records tie the diagnosis, dose, and product identity together for a clean claim. ## **Diagnosis and indication** List the exact diagnosis and subtype, such as Non-Hodgkin lymphoma subtypes, chronic lymphocytic leukemia, or rheumatoid arthritis. When relevant, include disease features like lymph nodes, lung involvement, central nervous system disease, or multiple sites. For vasculitis, describe renal risk such as rapidly progressive nephritic syndrome. ### **Drug identity and biosimilar selection** Name Ruxience clearly and document that the infused drug is rituximab-pvvr. This confirms Q5119 rather than originator rituximab or a different biologic. If your documentation summarizes differential entities or diseases classified as lymphoma, ensure the final, treated diagnosis is obvious. ### **Dose, units, and schedule** Record total milligrams infused and the plan. One unit of Q5119 equals 10 mg, so 500 mg equals 50 units. Include cycle details, for example 375 mg/m² for lymphoma regimens or two 1,000 mg doses separated by two weeks for rheumatoid arthritis. ### **Infusion details and safety** Capture start and stop times, premedications, and any infusion-related reactions with actions and outcomes. Note treatment changes for disease progression or intolerance. ### **Product handling and wastage** Document vial size, lot number, and whether any portion was discarded. State when the entire single-dose vial was used with no waste.

## **Q5119 billing requirements** Accuracy on units and pairing with administration codes keeps reimbursement predictable. ### **Units and claim math** Bill one unit per 10 mg of rituximab-pvvr administered. Match the billed units to the exact milligrams in the clinical note on the same date of service. ### **Infusion administration coding** Use chemotherapy or complex infusion services such as CPT 96413 for the first hour and 96415 for each additional hour when time thresholds are met. Report CPT 96375 if a distinct therapeutic IV push occurs during the encounter. ### **Prior authorization and coverage** Most payers require prior authorization for oncology and autoimmune indications. Submit the treatment plan, prior therapies, and confirmation that the product is Ruxience. Some plans have specific criteria for immune thrombocytopenic purpura or other disorders involving an immune mechanism, so include the policy-aligned rationale. ### **NDC and revenue reporting** Include the National Drug Code and correct revenue code when required. Ensure the number of Q5119 units equals the documented milligrams infused. ### **Wastage rules for single-dose vials** When a portion of a single-dose vial is discarded, bill the wasted amount on a separate line with modifier JW. When no drug is discarded, append modifier JZ to attest zero waste under current CMS policy.

## **Q5119 applicable modifiers** Use only the modifiers needed for a clear, policy-compliant claim. - **JW**: Report discarded drug amounts from a single-dose vial on a separate claim line. - **JZ**: Attest that zero drug was discarded when the full vial was used. - **KX**: Some payers request KX to indicate coverage criteria were met for certain indications. Use it only when a policy requires it.

## **Other relevant codes** Choose the code that matches the exact product to avoid denials. - **J9312**: Injection, rituximab (Rituxan), 10 mg, originator biologic - **Q5115**: Injection, rituximab-abbs (Truxima), 10 mg, biosimilar - **Q5123**: Injection, rituximab-arrx (Riabni), 10 mg, biosimilar - **J1745**: Injection, infliximab (Remicade), 10 mg, a different monoclonal and not a rituximab product

Frequently asked questions

Ruxience is rituximab-pvvr, a biosimilar to Rituxan with highly similar safety and effectiveness for the approved reference indications when payer policy allows. They are billed differently.

Bill 38 units on the administered line because Q5119 is per 10 mg and claims use whole units. If any drug was discarded, add a second line with modifier JW for the wasted amount so the total units equal the amount prepared from the vial(s). If no waste occurred, append JZ to the administered line.

Yes. Payers set diagnosis-specific frequency and cycle rules for follicular lymphoma, diffuse large B-cell disease, mantle cell lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis. Verify prior authorization and schedule requirements before each cycle to ensure continued coverage.