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Part B Biosimilar Biological Product Payment and Required Modifiers


Modifiers that identify the manufacturer of a biosimilar biological product are required on Part B claims. CMS updates assignment of modifiers to specific HCPCS codes quarterly. In situations where a HCPCS code is already associated with one or more modifiers and a new biosimilar biological product becomes available before its corresponding manufacturer’s modifier becomes effective, a not otherwise classified (NOC) code without a modifier may be used to bill for the new biosimilar product.

Below is the list of current biosimilar HCPCS Codes, the product(s) that are associated with each code and the corresponding required modifier that is used to identify the product. The table will be updated quarterly when new permanent HCPCS codes and modifiers are available for biosimilar products that appear on the ASP price file.

Q5101 Injection, Filgrastim (G-CSF), Biosimilar, 1 microgram Product Brand names - Zarxio Modifier - ZA - Novartis/Sandoz
Q5102 Injection, infliximab, biosimilar, 10 mg Product Brand names - Inflectra Modifier - ZB - Pfizer/Hospira
Q5102 Injection, infliximab, biosimilar, 10 mg Product Brand names - Renflexis Modifier - ZC –Merck/Samsung Bioepis

Note: The ZC modifier will become effective, that is, valid for claims submitted beginning October 1, 2017 and applies retroactively to dates of service on or after July 24, 2017.

For more information: https://go.usa.gov/xRQgQ

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