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New Biosimilar Modifier for Q5102

Rheumatology Practice Management October 2017 Vol 5 No 5 - Coding Corner
Jean Acevedo, LHRM, CPC, CHC, CENTC, AAPC Fellow
President and Senior Consultant
Acevedo Consulting
Delray Beach, FL

You may know by now that the Centers for Medicare & Medicaid Services created Healthcare Common Procedure Coding System (HCPCS) code Q5102 to be used when reporting “Injection, infliximab, biosimilar, 10 mg.” The October 2017 HCPCS update included a new modifier, ZC Merck/Samsung Bioepis, to be used with HCPCS code Q5102.

The new biosimilar to infliximab, infliximab-abda, was marketed on July 24, 2017, creating a situation in which drugs from 2 manufacturers—the other being infliximab-dyyb—may appear on claims depending on which biosimilar, if any, was administered. To identify the manufacturer of the specific biosimilar that was used, the new modifier, ZC, is required when HCPCS code Q5102 is billed on a claim for Merck/Samsung Bioepis submitted after October 1, 2017, regardless of the date of service. The ZC modifier will apply retroactively to dates of service on or after July 24, 2017.

Rheumatologists ordering and administering infliximab-abda should instruct their billing staff to add “ZC Merck/Samsung Bioepis” to the required modifiers that must be used when HCPCS code Q5102 is billed on a claim.

The official instruction, Change Request 10234, is available at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3850CP.pdf.

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Last modified: November 29, 2017
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