With the advent of biosimilars to the marketplace, the Centers for Medicare and Medicaid Services (CMS) now requires modifiers to identify the manufacturer of a biosimilar/biological product on Part B claims. Modifiers were put in place to provide the CMS with the necessary data needed to track claims payments, as well as the ability to understand the use of the biosimilar drugs.
Every quarter, the CMS will update the assignment of modifiers to specific Healthcare Common Procedure Coding System (HCPCS) codes. If a new biosimilar becomes available, and one or more modifiers are already associated with its assigned HCPCS code, then a Not Otherwise Classified (NOC) code without a modifier may be used to bill for the new biosimilar product. For more information, visit Part B Biosimilar Biological Product Payment and Required Modifiers.
Beginning Oct. 1, the ZC modifier will become effective and applied retroactively to dates of service on or after July 24, 2017, for Renflexis. The table below lists the existing modifiers that should be used to identify the current biosimilar/biological products on the market.
|Biosimilar HCPCS Code||Product Brand Name||Corresponding Required Modifier|
|Q5102 injection, infliximab, biosimilar, 10 mg||Inflectra||ZB—Pfizer/Hospira|
|Q5102 injection, infliximab, biosimilar, 10 mg||Renflexis||ZC—Merck/Samsung Bioepis|
For questions or information on coding and billing for these products, contact the ACR Practice Management Department at firstname.lastname@example.org.