AHA Coding Clinic® for HCPCS - 2017 Issue 3; For Your Information

New modifier for biosimilar biological product

For Medicare, hospitals outpatient facilities must report the required modifier to appropriately report biosimilar biological products. The modifier is used to distinguish between biosimilar products that appear in the same HCPCS code but are made by different manufacturers. The first modifier, specifically “ZB” was effective July 1, 2016, and the second modifier, specifically, “ZC” will be effective October 1, 2017. Modifier ZB or ZC must be reported with HCPCS code Q5102 (Injection, infliximab, biosimilar, 10 mg). Hospitals are advised to contact their respective payer to determine the payment effective date for each of the modifier. HCPCS Modifier...

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