April HCPCS update brings new codes for injections, immunotherapy treatment

CMS released Transmittal 3966 on February 2 describing changes that will be implemented in the April 2018 quarterly update to the HCPCS code set. These changes include updates to biosimilar biological product HCPCS codes, modifiers used with biosimilar biological products, and an autologous cellular immunotherapy treatment.

The request includes a new code for autologous cellular immunotherapy treatment, Q2041 (axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR T cells, including leukapheresis and dose preparation procedures, per infusion), and a revision to the descriptor for HCPCS code Q5101 (injection, filgrastim-sndz, biosimilar, [Zarxio], 1 microgram), which includes the trade name of the product.

In addition, HCPCS code Q5102 (injection, infliximab, biosimilar, 10 mg) will be replaced with two new codes to describe different versions of the drug.

These codes include:

• Q5103, injection, infliximab-dyyb, biosimilar (Inflectra), 10 mg
• Q5104, injection, infliximab-abda, biosimilar (Renflexis), 10 mg

All code changes will be effective April 1. 

A Medicare Part B policy outlined in the 2018 Medicare Physician Fee Schedule final rule describes how newly approved biosimilar biological products with a common reference product will no longer be grouped into the same billing code. The biosimilar payment policy makes the use of three modifiers that describe the manufacturer of a biosimilar product unnecessary. Effective April 1, CMS will no longer require the following modifiers:

• -ZA, Novartis/Sandoz
• -ZB, Pfizer/Hospira
• -ZC, Merck/Samsung Bioepis