Pharmacy Question for the Week of February 27, 2017

Question:

What biosimilars have been approved by the FDA, and how are they coded?

Answer:

Currently, Zarxio (reference product: Neupogen) and Inflectra (reference product: Remicade) are the only approved biosimilars, but additional Food & Drug Administration (FDA) approvals for biosimilars should occur in the near future.

Providers administering these products will need to remain current with coding and billing guidelines to ensure accurate assignment of HCPCS and the use of manufacturer-specific modifiers, such as the following:

Q5101

Injection, Filgrastim (G-CSF), biosimilar, 1 microgram
Modifier ZA—Novartis/Sandoz)

Q5102

Injection, Infliximab, biosimilar, 10 mg
Modifier ZB—Pfizer/Hospira

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Pharmacy Question for the Week of February 27, 2017

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