Health Information Management

Q&A: What are biosimilar products?

APCs Insider, June 5, 2015

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Q: We are receiving requests from our physicians regarding administration of a new drug: biosimilar filgrastim. We haven’t seen anything about a code for reporting this drug and we assume that the current code for filgrastim will not be appropriate to use.
A: A biosimilar product is a biological product that is very similar to an already approved biological product. In order to be approved by the FDA, the biosimilar must have no meaningful differences in terms of safety and effectiveness from the original product. Biosimilar filgrastim, which was approved by the FDA on March 6, 2015, is a new drug on the market. The new drug, called Zarxio®, is biosimilar to Neupogen®, and approved for the same indications as Neupogen.
CMS is releasing a new code for reporting Zarxio use beginning July 1, 2015. HCPCS code Q5101 is defined as “injection, filgrastim (G-CSF), biosimilar, 1 microgram.” The code can be reported beginning July 1, but is effective for dates of service after March 6, 2015, which is the FDA approval date. See Transmittal 3254 for more details.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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