Remicade and infliximab biosimilars — J1745, Q5103, Q5104, Q5121, Q5109

Infliximab products

Reference originator and four biosimilars, plus the subcutaneous maintenance product. All IV products share one unit basis (10 mg), the same FDA boxed warnings, and the same indication panel, but each has its own HCPCS code, NDC, and manufacturer. ASP comparison lives in Current Remicade pricing.

Zymfentra (infliximab-dyyb SC, J1748) is the subcutaneous maintenance product for Crohn's disease and ulcerative colitis after IV induction, and is billed under its own permanent J-code — it is not interchangeable with any of the five IV codes above.

Inflectra (Q5103)

Pfizer / Celltrion · lead NDC 0069-0809-01 (11-digit claim form: 00069-0809-01) · 100 mg single-dose vial, same 1 unit = 10 mg basis as Remicade.

Renflexis (Q5104)

Organon / Samsung Bioepis · lead NDC 78206-162-01 (11-digit claim form: 78206-0162-01) · 100 mg single-dose vial.

Avsola (Q5121)

Amgen · lead NDC 55513-203-01 (11-digit claim form: 55513-0203-01) · 100 mg single-dose vial.

Ixifi (Q5109)

Pfizer · lead NDC 0069-0331-01 (11-digit claim form: 00069-0331-01) · discontinued / limited supply — verify availability before billing.

Remicade dosing by indication

Induction runs at weeks 0, 2, and 6 for every indication, dosed by weight (mg/kg); maintenance then varies by indication.

Premedications

Common premedication regimens include diphenhydramine, acetaminophen, and hydrocortisone, with hydrocortisone reserved for patients with prior infusion reactions or a higher-risk profile. Each agent bills its own admin code and J-code, separate from the infliximab administration. The prescribing clinician sets the protocol.

First-dose administration setting

Because of the FDA-flagged risk of acute infusion reactions and the ~2-hour minimum infusion time, first doses are typically administered in a setting with immediate access to resuscitation (hospital outpatient, AIC, or office equipped with emergency medications). Subsequent doses can move to lower-cost sites of care per payer site-of-care UM rules.

Need the billing units for a patient? Convert dose to J1745 billing units →

Remicade billing reference

HCPCS

J1745 — 10 mg per billing unit. The same 10 mg unit basis applies to all five infliximab HCPCS codes (originator and biosimilars).

NDCs

Lead NDC 57894-030-01 (Remicade, Janssen Biotech labeler 57894). Pad to 11 digits with a leading zero in the appropriate segment for CMS-1500 Box 24A.

Administration

Common Remicade administration coding uses 96413 (initial hour) and 96415 (each additional hour) — CPT's chemotherapy/complex-biologic infusion administration codes. Some payers require the non-chemotherapy pair (96365/96366) instead; follow the payer's policy.

Premedication billing

Modifiers

JZ — required when no drug discarded. JW — required for documented waste of unused single-dose-vial drug. JW applies to most infliximab infusions because dosing is weight-based and 100 mg vials rarely match the calculated dose exactly.

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. For infliximab, JZ applies when the calculated mg dose is an exact multiple of 100 mg (the vial size) — no waste. Append JZ to the J1745 / Q5103 / Q5104 / Q5121 / Q5109 line.

For most weight-and-dose combinations, the calculated mg dose is not an exact multiple of 100 mg, so partial-vial waste is the rule. CMS requires the JW modifier on a separate claim line for the discarded units (rounded per CMS rules), with the wastage documented in the medical record. Bill administered units (no wastage modifier) and discarded units (with JW) on two separate lines, same date of service, same HCPCS code.

TB — 340B drug pricing. Hospitals that purchase infliximab through 340B and bill Medicare report the TB modifier — the sole 340B identifier since CMS discontinued JG on January 1, 2025. Most infusion suites do not use 340B pricing; only the hospital-outpatient setting does.

Modifier 25 — same-day E/M. Append modifier 25 to the same-day E/M code if a significant, separately identifiable evaluation occurred. Routine pre-infusion check-in is bundled.

Claim form

CMS-1500 / 837P (physician office, AIC; POS 11/49) field map for a J1745 claim.

Calculate units, vials & JW/JZ →

Remicade coverage

• 25 of 30 commercial payer policy sets require prior authorization
• 20 name a preferred infliximab product
• Requirements vary by diagnosis, payer and site of care
• As of 2026, UnitedHealthcare requires biosimilar use unless documented medical necessity for Remicade; Aetna and Cigna prefer the lowest-cost biosimilar option
• UnitedHealthcare, Aetna, Cigna, and most BCBS plans apply site-of-care utilization management to specialty infusion drugs
• After tolerated infusions, payers typically require subsequent doses to move out of hospital outpatient into office or an in-network ambulatory infusion center

ICD-10 codes by indication

Use the most specific code supported by chart documentation. Each indication has a distinct code family.

See Medicare covered diagnoses for infliximab for the MAC-level ICD-10 ranges.

Site of care / POS

Payer site-of-care UM and the patient's reaction-risk profile decide the first-dose setting: office (POS 11), AIC (POS 49), or hospital outpatient (POS 22 on-campus, 19 off-campus). Subsequent doses move to the lowest-cost site the plan allows.

Check the patient's actual policy: See Remicade coverage by payer →

Current Remicade pricing

Medicare ASP+6%: $31.479 / 10 mg · $1,259.16 / 400 mg. Sequestration reduces Medicare's 80% share by 2% (effective ASP+4.3% overall). Commercial plans pay a contracted rate that differs by payer and state.

Look up commercial reimbursement →

Patient cost

The patient's actual responsibility depends on: payer allowed rate · benefits · − assistance · = patient responsibility.

Calculate a Remicade patient estimate →

Copay & financial assistance

Commercial: J&J withMe savings available for eligible patients. Medicare: diagnosis-specific charitable funds may be available.

See current Remicade assistance programs →

Common Remicade denials & fixes