Q5135
Q5135 – Inj, tyenne, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II Q-code · Medicare Part B drug billing
Q-code
● 7 NDCs crosswalked per 1 MG $4.056/unit ASP+6%
📋 Q5135 summary
Q5135 is a HCPCS Level II Q-code used to bill tyenne, 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 Q5135: Tyenne Autoinjector*, Tyenne
Code Q5135
Billing unit 1 MG Payment limit $4.056/unit NDC-Crosswalk 7
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 codeQ5135
DescriptorInj, tyenne, 1 mg
Billing unit1 MG
Payment limit / unit$4.056
Est. ASP / unit$3.826 est.
Mapped NDCs7
Data periodQ3 2026
Last updated2026-08-20
💊 About Tocilizumab Injection DRUG GUIDE
Tocilizumab injection is used to treat several serious inflammatory and immune-related conditions.
Actemra (tocilizumab) is indicated for moderately to severely active rheumatoid arthritis in adults who haven't responded well to other disease-modifying drugs, giant cell arteritis in adults, systemic sclerosis-associated interstitial lung disease (SSc-ILD) to slow lung function decline, polyarticular and systemic juvenile idiopathic arthritis in patients 2 years and older, and severe or life-threatening cytokine release syndrome (CRS) caused by CAR T-cell therapy in adults and children 2 and older.Actemra is also approved for hospitalized adults and children aged 2 and older with COVID-19 who are on corticosteroids and need supplemental oxygen or mechanical breathing support.
Not every brand or route is approved for every use — your prescriber will choose the right form for your specific condition.
Clinical overview from our editorial drug guide for Tocilizumab Injection. For billing reference, see the sections above.
🧾 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
$4.056
Est. ASP / unit
$3.826 est.
Est. after 2% sequester
$3.975
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 Q5135 = 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 Q5135 LEAST EXPENSIVE FIRST
7 NDCs map to Q5135. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($4.056/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 65219-0584-01 | TYENNE Tocilizumab-aazg 162 mg/.9mL INJECTION, SOLUTION | Fresenius | 1 SYRINGE, GLASS in 1 CARTON (65219-584-01... | 162 mg/.9mL | 162 | $657.07 | $820.997 | ● Active | CMS + PDAC |
| 65219-0596-01 | TYENNE Tocilizumab-aazg 162 mg/.9mL INJECTION, SOLUTION | Fresenius | 1 SYRINGE, GLASS in 1 CARTON (65219-596-01... | 162 mg/.9mL | 180 | $730.08 | $820.997 | ● Active | PDAC |
| 65219-0586-04 | TYENNE Tocilizumab-aazg 162 mg/.9mL INJECTION, SOLUTION | Fresenius | 1 SYRINGE, GLASS in 1 CARTON (65219-586-04... | 162 mg/.9mL | 162 | $657.07 | — | ● Active | CMS + PDAC |
| 65219-0590-04 | TYENNE Tocilizumab-aazg 80 mg/4mL INJECTION, SOLUTION, CONCENTRATE | Fresenius | 1 VIAL, SINGLE-DOSE in 1 CARTON (65219-590... | 80 mg/4mL | 80 | $324.48 | — | ● Active | CMS + PDAC |
| 65219-0592-10 | TYENNE Tocilizumab-aazg 200 mg/10mL INJECTION, SOLUTION, CONCENTRATE | Fresenius | 1 VIAL, SINGLE-DOSE in 1 CARTON (65219-592... | 200 mg/10mL | 200 | $811.20 | — | ● Active | CMS + PDAC |
| 65219-0594-20 | TYENNE Tocilizumab-aazg 400 mg/20mL INJECTION, SOLUTION, CONCENTRATE | Fresenius | 1 VIAL, SINGLE-DOSE in 1 CARTON (65219-594... | 400 mg/20mL | 400 | $1,622.40 | — | ● Active | CMS + PDAC |
| 65219-0598-10 | TYENNE Tocilizumab-aazg 162 mg/.9mL INJECTION, SOLUTION | Fresenius | 1 SYRINGE, GLASS in 1 CARTON (65219-598-10... | 162 mg/.9mL | 180 | $730.08 | — | ● 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
$8.37M
Claims
4,349
Beneficiaries
1,945
Spend / beneficiary
$4,300.83
Spend / claim
$1,923.46
Trend by period
Where Q5135 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #196 of 824
#191
EUFLEXXA J7323
$8.7M
#192
RETACRIT(Q5106) Q5106
$8.68M
#193
QUTENZA J7336
$8.51M
#194
DEXTENZA J1096
$8.47M
#195
XOFIGO A9606
$8.42M
#196
TYENNE AUTOINJECTOR* Q5135
$8.37M
#197
TNKASE J3101
$8.36M
#198
TECENTRIQ HYBREZA J9024
$8.26M
#199
XEOMIN J0588
$8.12M
#200
ADMELOG SOLOSTAR* J1817
$8M
#201
PEMGARDA (EUA) Q0224
$7.66M
Total claims — #237 of 824
#232
FYLNETRA Q5130
4,408
#233
CEFAZOLIN SODIUM-DEX... J0690
4,394
#234
ADRIAMYCIN* J9000
4,382
#235
CARNITOR* J1955
4,361
#236
SAPHNELO J0491
4,352
#237
TYENNE AUTOINJECTOR* Q5135
4,349
#238
TRAZIMERA Q5116
4,194
#239
CEFEPIME HCL J0692
4,085
#240
LACTATED RINGERS J7120
4,078
#241
HERCEPTIN J9355
4,057
#242
EPIFIX 1 SQ CM** Q4186
3,996
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) | $8.37M | 1,945 | 4,349 | $4,300.83 | $1,923.46 |
| 2025 (Q1-Q4) | $21.4M | 2,260 | 10,595 | $9,467.40 | $2,019.47 |
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
$7.06M
Medicare paid
$5.43M
Submitted services
1,664,054
Denial rate
2.7%
Allowed / service
$4.36
Submitted charges
$20.75M
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 Q5135 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 26,758 services across 1 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
📊 What bills under Q5135
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)
7 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
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.
❓ Q5135 billing FAQ
What is HCPCS code Q5135?
Q5135 is a HCPCS Level II Q-code used to bill Inj, tyenne, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for Q5135?
One unit of Q5135 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of Q5135 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 Q5135?
The Medicare Part B payment limit is $4.056 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $3.975 per unit. Payment limits are revised quarterly.
Which NDCs bill under Q5135?
7 NDCs currently map to Q5135 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 Q5135 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.