HERZUMA Q Code: Q5113

Drug & Product Overview

HCPCS Descriptor Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg

HCPCS Added Date July 1, 2019

Manufacturer Teva

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose, Multi-Dose

Dosage Form Injection, Powder, Lyophilized, For Solution | Kit

About HERZUMA

Herzuma is a medication aligned to the HCPCS Q Code: Q5113 for billing, pricing, and reimbursement purposes in the United States. Classified under Oncology, it is administered via the intravenous route and manufactured by Teva.

According to CMS Drug Use Information: Trastuzumab is used to treat certain types of breast, stomach, or esophagus cancer. Trastuzumab belongs to a class of medications known as monoclonal antibodies. It works by slowing or stopping the growth of cancer cells. This monograph is about the following trastuzumab products: trastuzumab, trastuzumab-anns, trastuzumab-dkst, trastuzumab-dttb, trastuzumab-pkrb, trastuzumab-qyyp, trastuzumab-strf.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
63459-0303-43	Herzuma	Cephalon, Inc.	15	150 MG / 7.15 ML
63459-0305-47	Herzuma	Cephalon, Inc.	42	Kit

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HERZUMA Pricing & Reimbursement

Q5113 Private Payer Reimbursement

$61.62 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

Trastuzumab Biosimilar Information:

HERZUMA Approval Date: December 14, 2018

Product Name	HCPCS Code	Active Ingredient	BLA Type
Herceptin	J9355	Trastuzumab	351(a) Originator Product
Ogivri	Q5114	Trastuzumab	351(k) Biosimilar
Herzuma	Q5113	Trastuzumab	351(k) Biosimilar
Ontruzant	Q5112	Trastuzumab	351(k) Biosimilar
Trazimera	Q5116	Trastuzumab	351(k) Biosimilar
Kanjinti	Q5117	Trastuzumab	351(k) Biosimilar
Hercessi	Q5146	Trastuzumab	351(k) Biosimilar

HERZUMA Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 11.07%

Avg. Days to File 5.6days

Avg. Days to Pay 24.7days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore Q5113 claims analytics on FocalPoint →

HERZUMA CPT Administration Codes

CPT Code	Description
96413	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

Not on the CMS JW / JZ list

CMS does not include Herzuma (Q5113) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q5113. Wastage billing guide →

HERZUMA Medically Unlikely Edits (MUE)

The most billing units of Q5113 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient

120 units / day

= 1,200 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

HERZUMA Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Breast Cancer Metastatic Breast Cancer Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma

Drug Class

HER2/Neu/cerbB2 Antagonists [MoA]HER2/neu Receptor Antagonist [EPC]

Frequently Asked Questions

Is there an available Herzuma billing and coding guide?

Our team has not identified a manufacturer-published source of billing and coding information for HERZUMA.

Are there any available Herzuma patient assistance programs?

HERZUMA patient assistance information can be found through Teva. Visit Here →

Where can I find Herzuma prescribing information?

HERZUMA prescribing information can be found at the link below: Visit Here →

Where can I find Herzuma side effect information?

Information regarding HERZUMA's side effects can be found at MedlinePlus Visit Here →

Does billing HERZUMA require JZ/JW wastage modifiers?

CMS does not include HERZUMA (Q5113) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing Q5113. For more information, visit the link below.

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