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Updated July 1st, 2026

RENFLEXIS Q Code: Q5104

Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

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Q4 2026 Medicare Payment Limit for Q5104, effective October 1, 2026: $25.649 per HCPCS billing unit, down 3.6% from $26.615. From CMS's final file.

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Medicare Payment Limit ?
$26.615
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$26.615
/ HCPCS billing unit · APC 9036
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
3
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Drug & Product Overview

HCPCS Descriptor Injection, infliximab-abda, biosimilar, (renflexis), 10 mg
HCPCS Added Date April 1, 2018
Manufacturer Organon
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Powder, Lyophilized, For Solution | Not Available

About RENFLEXIS

Renflexis is a medication aligned to the HCPCS Q Code: Q5104 for billing, pricing, and reimbursement purposes in the United States. Classified under Immunology: Anti-TNF, it is administered via the intravenous route and manufactured by Organon.

According to CMS Drug Use Information: This medication is used to treat certain types of arthritis (rheumatoid arthritis, arthritis of the spine, psoriatic arthritis), certain bowel diseases (Crohn's disease, ulcerative colitis), and a certain severe skin disease (chronic plaque psoriasis). In these conditions, the body's defense system (immune system) attacks healthy tissues. Infliximab works by blocking the actions of a certain natural substance (tumor necrosis factor alpha) in the body. This helps to decrease swelling (inflammation) and weaken your immune system, which slows or stops the damage from the disease. This monograph is about the following infliximab products: infliximab, infliximab-abda, infliximab-axxq, and infliximab-dyyb.

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. Showing 1 of 3 NDCs — log in for the full crosswalk.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
78206-0162-01 Renflexis Organon LLC 10 100 MG
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RENFLEXIS
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RENFLEXIS Pricing & Reimbursement

Q5104 Private Payer Reimbursement
$27.56 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

Infliximab Biosimilar Information:

RENFLEXIS Approval Date: April 21, 2017

Product Name HCPCS Code Active Ingredient BLA Type
Remicade J1745 Infliximab 351(a) Originator Product
Inflectra J1748 Infliximab 351(k) Biosimilar
Inflectra Q5103 Infliximab 351(k) Biosimilar
Renflexis Q5104 Infliximab 351(k) Biosimilar
Avsola Q5121 Infliximab 351(k) Biosimilar

RENFLEXIS Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 9.7%
Avg. Days to File 6.0days
Avg. Days to Pay 23.7days

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

Explore Q5104 claims analytics on FocalPoint →
OnPoint Oncology

RENFLEXIS CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

CPT Code Description
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
JW / JZ modifiers apply

CMS has identified Renflexis (Q5104) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

RENFLEXIS Medically Unlikely Edits (MUE)

The most billing units of Q5104 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient
150 units / day
= 1,500 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 →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

RENFLEXIS 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.

Ankylosing Spondylitis Crohn's Disease Fistulizing Crohn's Disease Pediatric Crohn's Disease Pediatric Ulcerative Colitis Plaque Psoriasis Psoriatic Arthritis Rheumatoid Arthritis Ulcerative Colitis
Drug Class
Tumor Necrosis Factor Blocker [EPC]Tumor Necrosis Factor Receptor Blocking Activity [MoA]

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Frequently Asked Questions

Is there an available Renflexis billing and coding guide?
Billing and coding information for RENFLEXIS can be found through Organon. Visit Here →
Are there any available Renflexis patient assistance programs?
RENFLEXIS patient assistance information can be found through Organon. Visit Here →
Where can I find Renflexis prescribing information?
RENFLEXIS prescribing information can be found at the link below. Please reach out to us if you believe this information to be innacurate or out of date. Visit Here →
Where can I find Renflexis side effect information?
Our team has not yet identified a source of side effects information for RENFLEXIS. Please check back in a few weeks.
Does billing RENFLEXIS require JZ/JW wastage modifiers?
CMS has identified RENFLEXIS(Q5104) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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