No. Q5133 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code.

What NDCs are billed under Q5133?

CMS's ASP crosswalk for October 1, 2026 through December 31, 2026 lists 6 NDCs under Q5133, for Tofidence. The table on this page shows each one with its billing units per package.

What is the Medicare payment limit for Q5133?

$4.706 per 1 mg, effective October 1, 2026 through December 31, 2026, from CMS's Part B drug payment limit file. Multiply by the units billed for the allowed amount before deductible and coinsurance. It is not a coverage decision.

What is one billing unit of Q5133?

One unit of Q5133 is 1 mg, as stated in the code's descriptor. Units to report = dose given ÷ 1 mg.

Q5133 HCPCS Code: Tofidence (tocilizumab-bavi)

In short

Q5133 is the HCPCS Level II code for injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg. CMS assigns NDCs for Tofidence to it. One billing unit is 1 mg. The Medicare Part B payment limit is $4.706 per unit (October 1, 2026 through December 31, 2026).

Code

CMS HCPCS file

HCPCS codeQ5133

Billing unit1 mg

Descriptor: Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
Short descriptor: Inj, tofidence, 1 mg
Code set: HCPCS Level II, maintained by CMS
Effective: Oct 1, 2024

The billing unit is read from the descriptor. Confirm it against the CMS file before billing.

Medicare Part B payment limit

CMS ASP file

Payment limit per unit$4.706

Per1 mg

Coinsurance20%

Effective October 1, 2026 through December 31, 2026. Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data. CMS note: 8% of reference add-on applied. A payment limit is not a coverage decision; the Medicare contractor decides coverage. CMS ASP pricing files

Units and claim line

Units = dose given ÷ 1 mg. For example, 100 mg is 100 units. Enter the dose to get the units and the NDC line for the CMS-1500 and the 837P.

Dose given (mg)

HCPCS units (1 unit = 1 mg)

Modifier

NDC (11-digit)

NDC unit qualifier

NDC quantity

Enter the dose given to build the claim line.

NDCs billed under Q5133

CMS’s ASP NDC–HCPCS crosswalk (effective October 1, 2026 through December 31, 2026) assigns 6 NDCs to Q5133 for Tofidence. Billing units per package are CMS’s figures for this code’s unit.

NDCs assigned to Q5133 in the CMS ASP crosswalk
Drug	NDC (11-digit)	Labeler	Package	Billing units per package
Tofidence	64406-0022-01	Organon LLC	10	200
Tofidence	64406-0023-01	Organon LLC	20	400
Tofidence	64406-0024-01	Organon LLC	4	80
Tofidence	78206-0200-01	Organon LLC	4	80
Tofidence	78206-0201-01	Organon LLC	20	200
Tofidence	78206-0202-01	Organon LLC	20	400

Q5133: common questions

Is Q5133 a CPT code?: No. Q5133 is a HCPCS Level II code, maintained by CMS, that identifies the drug supplied. CPT codes are five-digit numbers from the AMA that describe services. Giving the drug, for example an injection or infusion, is usually reported with a separate CPT administration code. CPT codes for drug administration.
What NDCs are billed under Q5133?: CMS's ASP crosswalk for October 1, 2026 through December 31, 2026 lists 6 NDCs under Q5133, for Tofidence. The table on this page shows each one with its billing units per package.
What is the Medicare payment limit for Q5133?: $4.706 per 1 mg, effective October 1, 2026 through December 31, 2026, from CMS's Part B drug payment limit file. Multiply by the units billed for the allowed amount before deductible and coinsurance. It is not a coverage decision.
What is one billing unit of Q5133?: One unit of Q5133 is 1 mg, as stated in the code's descriptor. Units to report = dose given ÷ 1 mg. J-code billing units.

Q5133 — Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg