TOFIDENCE Q Code: Q5133
Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
Drug & Product Overview
About TOFIDENCE
Tofidence is a medication aligned to the HCPCS Q Code: Q5133 for billing, pricing, and reimbursement purposes in the United States. It is an Antibiotic drug administered via the intravenous route and manufactured by Biogen.
According to CMS Drug Use Information: This medication is used to treat rheumatoid arthritis in adults and in children (such as systemic juvenile idiopathic arthritis-SJIA, polyarticular juvenile idiopathic arthritis-PJIA). It helps to reduce pain and swelling due to rheumatoid arthritis. Tocilizumab can also be used to treat giant cell arteritis. It helps to reduce swelling in your blood vessels so blood can flow more easily. Tocilizumab may be used to treat a reaction (Cytokine Release Syndrome-CRS) caused by certain cancer treatments. Tocilizumab is also used in combination with a corticosteroid (such as dexamethasone) to treat coronavirus disease (COVID-19) in hospitalized patients who need supplemental oxygen (including patients on a mechanical ventilator). Tocilizumab belongs to a class of drugs known as Interleukin-6 (IL-6) blockers. It works by blocking IL-6, a substance made by the body that causes swelling (inflammation). This monograph is about the following tocilizumab products: tocilizumab, tocilizumab-aazg, tocilizumab-anoh, and tocilizumab-bavi.
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 5 of 6 NDCs — log in for the full crosswalk.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| 64406-0022-01 | Tofidence | Biogen MA Inc | 200 | 80 MG / 4 ML |
| 64406-0023-01 | Tofidence | Biogen MA Inc | 400 | 200 MG / 10 ML |
| 64406-0024-01 | Tofidence | Biogen MA Inc | 80 | 400 MG / 20 ML |
| 78206-0200-01 | Tofidence | Organon LLC | 80 | 80 MG / 4 ML |
| 78206-0201-01 | Tofidence | Organon LLC | 200 | 200 MG / 10 ML |
| •••••-••••-•• Log in to view | TOFIDENCE | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
TOFIDENCE Pricing & Reimbursement
National median reimbursement across major commercial payers.
Create an account on PayerPrice for more information →
Historical Graphing and Billing Calculator
Log in to calculate billing and reimbursement with live ASP, WAC & AWP pricing.
Login to use the calculator →Tocilizumab Biosimilar Information:
TOFIDENCE Approval Date: September 29, 2023
| Product Name | HCPCS Code | Active Ingredient | BLA Type |
|---|---|---|---|
| Actemra | J3262 | Tocilizumab | 351(a) Originator Product |
| Tofidence | Q0234 | Tocilizumab | 351(k) Biosimilar |
| Tofidence | Q5133 | Tocilizumab | 351(k) Biosimilar |
| Tyenne | Q0238 | Tocilizumab | 351(k) Biosimilar |
| Tyenne | Q5135 | Tocilizumab | 351(k) Biosimilar |
| Avtozma | Q0237 | Tocilizumab | 351(k) Interchangeable |
| Avtozma | Q5156 | Tocilizumab | 351(k) Interchangeable |
TOFIDENCE 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) |
This product is new and does not yet appear on the CMS list of HCPCS pertaining to single-dose containers. Wastage billing guide →
TOFIDENCE Medically Unlikely Edits (MUE)
The most billing units of Q5133 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.
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 →
TOFIDENCE Clinical Information
Indications and drug classification.
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.
Login for BuyandBill.com Analytics
Unlock deeper insights with BuyandBill’s Comparative Report!
- Compare ASP, WAC, and AWP across drugs.
- Visualize Drug Price Movement Over Time
- Tailor reports to drug class, manufacturer, or HCPCS Code.
- Compare Biosimilar and 505(b)(2) products.
Frequently Asked Questions
Is there an available TOFIDENCE billing and coding guide?
Are there any available TOFIDENCE patient assistance programs?
Where can I find TYRUKO prescribing information?
Where can I find TOFIDENCE side effect information?
Does billing TOFIDENCE require JZ/JW wastage modifiers?
About BuyandBill.com:
The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.
Related Drug Codes
Explore billing, coding, and pricing for drugs related to TOFIDENCE.
