Q5133
Q5133 – Inj, tofidence, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 5 NDCs crosswalked per 1 MG $5.013/unit ASP+6%
📋 Q5133 summary
Q5133 is a HCPCS Level II Q-code used to bill tofidence, 1 mg, billed per 1 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with Q5133: Tofidence
Code Q5133
Billing unit 1 MG Payment limit $5.013/unit NDC-Crosswalk 5
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeQ5133
DescriptorInj, tofidence, 1 mg
Billing unit1 MG
Payment limit / unit$5.013
Est. ASP / unit$4.729 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$5.013
Est. ASP / unit
$4.729 est.
Est. after 2% sequester
$4.913
HCPCS dosage
1 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of Q5133 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under Q5133 WITH EST. MEDICARE PAY
5 NDCs map to Q5133. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($5.013/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 64406-0022-01 | Tofidence Tocilizumab 20 mg/mL INJECTION | Biogen | 1 VIAL, SINGLE-USE in 1 CARTON (64406-022-... | 20 mg/mL | 200 | $1,002.60 | — | ● Active | CMS ASP |
| 64406-0023-01 | Tofidence Tocilizumab 20 mg/mL INJECTION | Biogen | 1 VIAL, SINGLE-USE in 1 CARTON (64406-023-... | 20 mg/mL | 400 | $2,005.20 | — | ● Active | CMS ASP |
| 64406-0024-01 | Tofidence Tocilizumab 20 mg/mL INJECTION | Biogen | 1 VIAL, SINGLE-USE in 1 CARTON (64406-024-... | 20 mg/mL | 80 | $401.04 | — | ● Active | CMS ASP |
| 78206-0202-01 | TOFIDENCE TOCILIZUMAB 400 mg/20mL INJECTION | Organon | 1 VIAL, SINGLE-DOSE in 1 CARTON (78206-202... | 400 mg/20mL | 400 | $2,005.20 | — | ● Active | CMS + PDAC |
| 78206-0201-01 | TOFIDENCE TOCILIZUMAB 200 mg/10mL INJECTION | Organon | 1 VIAL, SINGLE-DOSE in 1 CARTON (78206-201... | 200 mg/10mL | 20 | $100.26 | — | ● Active | PDAC |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$4.45M
Claims
1,736
Beneficiaries
855
Spend / beneficiary
$5,204.32
Spend / claim
$2,563.19
Trend by period
Where Q5133 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #250 of 824
#245
GIVLAARI J0223
$4.73M
#246
VONVENDI J7179
$4.7M
#247
HYALGAN* J7321
$4.54M
#248
INVEGA SUSTENNA J2426
$4.49M
#249
CYCLOPHOSPHAMIDE(J90... J9072
$4.47M
#250
TOFIDENCE Q5133
$4.45M
#251
HERZUMA Q5113
$4.43M
#252
GENVISC 850 J7320
$4.4M
#253
LANREOTIDE ACETATE(J... J1932
$4.36M
#254
PURAPLY AM 1 SQ CM** Q4196
$4.19M
#255
ALIMTA* J9305
$4.17M
Total claims — #331 of 824
#326
EMTRICITABINE-TENOFO... J0750
1,859
#327
ZOLADEX J9202
1,858
#328
DAPTOMYCIN(J0872) J0872
1,843
#329
JEVTANA J9043
1,832
#330
QUZYTTIR J1201
1,770
#331
TOFIDENCE Q5133
1,736
#332
BIVIGAM J1556
1,700
#333
ERIBULIN MESYLATE* J9179
1,689
#334
TYVASO INSTITUTIONAL... J7686
1,683
#335
MONJUVI J9349
1,625
#336
ASCENIV J1554
1,618
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $4.45M | 855 | 1,736 | $5,204.32 | $2,563.19 |
| 2025 (Q1-Q4) | $5.68M | 672 | 2,124 | $8,452.46 | $2,674.22 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$3.45M
Medicare paid
$2.66M
Submitted services
637,785
Denial rate
3.9%
Allowed / service
$5.63
Submitted charges
$7.14M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where Q5133 is utilized
⏳
The geographic utilization map is building for this code — it aggregates millions of CMS Part B claim lines, then caches the result. Refresh in a moment; if it doesn’t appear, this code may have no reportable Part B utilization.
📊 What bills under Q5133
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Not available in current dataset
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
5 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ Q5133 billing FAQ
What is HCPCS code Q5133?
Q5133 is a HCPCS Level II Q-code used to bill Inj, tofidence, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5133?
One unit of Q5133 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of Q5133 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for Q5133?
The Medicare Part B payment limit is $5.013 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $4.913 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5133?
5 NDCs currently map to Q5133 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean Q5133 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.