Pharmacy Question for the Week of March 19, 2018

Pharmacy Compliance Question of the Week


Are modifiers required when billing biosimilar products?


Beginning on April 1, 2018, modifiers that describe the manufacturer of a biosimilar product (for example, ZA, ZB and ZC) will no longer be required on Medicare claims for HCPCS codes for biosimilars. However, HCPCS code Q5102 and the requirement to use biosimilar modifiers remain in effect for dates of service prior to April 1, 2018. Q5102 will be discontinued on April 1 and replaced with the following:

Q5102 Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg
Q5014 Injection, infliximab-abda, biosimilar, (renflexis), 10 mg

NOTE: This answer has been corrected in the 3/26/18 Compliance Question of the Week. You can find it here.

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.