Q5103 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg.
National Average Payment
Non-Facility (Private Office) Rate
ℹ️ Good to Know
This item has a standard price nationwide. Your local rate will likely match the amount shown above.
Code Description
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Local Estimate Demo
Pick a demo zip (or type yours) and choose the setting. Then jump into MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to calculate your locality-adjusted estimate.
How is this calculated?
Here’s the transparent math behind the estimate for HCPCS Level II code Q5103. For locality-adjusted results, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Methodology
This code is paid using: Average Sales Price (ASP) + 6%.
This item is typically standardized nationally, but coverage and claim details can still affect final payment.
Open MedFeeSchedule's Medicare Physician Fee Schedule Lookup ToolReimbursement Summary
The 2026 National Medicare reimbursement for Q5103 is $26.04. This item is paid at a standard national rate, so local variation is typically minimal.
Description: Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg. Payment policies and coverage rules can still vary by setting and claim details, so confirm final guidance through CMS when needed.
Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For Q5103 (Drug / Biological), the payment methodology may not include both facility and non-facility rates.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Historical Medicare Reimbursement
| Year | Non-Facility Rate | Facility Rate | Year-over-Year % Change |
|---|---|---|---|
| 2026 | Coming Soon (Pro) | Coming Soon (Pro) | Coming Soon |
| 2025 | Coming Soon (Pro) | Coming Soon (Pro) | Coming Soon |
| 2024 | Coming Soon (Pro) | Coming Soon (Pro) | Coming Soon |
| 2023 | Coming Soon (Pro) | Coming Soon (Pro) | Coming Soon |
Historical trends and quarterly breakouts are launching as part of Pro. This preview shows where multi-year analytics will appear once the full dataset is available.
Pro includes historical graphs, deeper year ranges, and export tools. Learn more and join early access.
View Pro Plan (Coming Soon)Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for Q5103?
The 2026 National Average Medicare reimbursement rate for Q5103 (Drug / Biological) is $26.04. This rate is effective as of January 1, 2026.
What is the description for code Q5103?
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Why do facility and non-facility payments differ for Q5103?
Facility vs. non-facility differences usually apply to RVU-based physician services. Q5103 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for Q5103?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is Q5103 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.