Q&A: Which modifier do we use for Merck's infliximab biosimilar?

Q: We are using a biosimilar for infliximab but it is manufactured by Merck/Samsung rather than Pfizer/Hospira. CMS requires that a manufacturer specific modifier be appended to the HCPCS code. Is there a new one for Merck/Samsung?

A: In Transmittal 3864, the October 2017 OPPS update, CMS established modifier –ZC to represent Merck/Samsung Bioepis as the manufacturer. This modifier is effective retroactive to July 1, 2017, applicable to dates of service on or after July 24, 2017, and is to be appended to HCPCS code Q5102 (injection, infliximab, biosimilar, 10 mg) when the manufacturer is Merck/Samsung Bioepis. Modifier -ZB remains effective for this code as well to represent Pfizer/Hospira.

Providers will need to ensure that the appropriate modifier is appended based on the manufacturer for the biosimilar that is administered to the patient.

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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