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.


CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

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.