Q&A: How do we report new biosimilar products?

May 18, 2016
Medicare Web

Q: Are there any new HCPCS codes for recently released biosimilar products on the horizon? Our physicians and pharmacists are being contacted by the manufacturer about purchasing and using them, but we want to be sure we can report them appropriately.

A: As a matter of fact, yes. There is a new HCPCs code in the July 2016 HCPCS list. Q5102 (injection, infliximab, biosimilar, 10 mg) will be reportable beginning with the July update, with an effective date of April 5, 2016. This means it can be reported for dates of service beginning April 5, but not reported until July 1 when the OCE is ready to accept the new HCPCS code.

There is also a new HCPCS modifier that is applicable to biologicals beginning in July. CMS is establishing modifier -ZB to be reported when the biosimilar is manufactured by Pfizer/Hospira. The modifier will also have an effective date of April 5, 2016.

This is a good time for providers to review their charging and reporting processes to ensure that there is a mechanism for identifying the manufacturer of the product actually provided to the patient so that it is included on the claim. While currently there are only two biosimilar manufacturer modifiers in play, it is obvious that there will be more added, as this is the second new modifier that has become effective this year. Now is a good time to validate the process.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.


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