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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Article Overview
This article covers a Medicare outpatient billing update involving biosimilar biological products, the HCPCS modifier changes tied to manufacturer distinction, and the timing of the reported updates. It is relevant for hospital outpatient coding, billing, and reimbursement staff who need to track HCPCS modifier changes and payer-specific effective dates. The article also identifies the related HCPCS code and the modifiers introduced for this topic.
Why This Topic Matters
Facilities that report biosimilar biological products need current HCPCS modifier information to align claims reporting with Medicare outpatient requirements and payer effective dates.
What You Will Learn
- The article’s focus on biosimilar biological product reporting in the hospital outpatient setting.
- How the topic is tied to HCPCS modifier updates and effective dates.
- Why payer-specific timing matters for reporting-related changes.
- The relevant HCPCS code referenced in the discussion.
Who Should Read This
- Hospital outpatient coders
- Billing staff
- Revenue cycle teams
- Compliance staff
- Medical coding professionals
Codes Discussed
Modifiers Discussed
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