Health Information Management

Q&A: Which code do I use to report a biosimilar of filgrastim?

APCs Insider, December 11, 2015

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Q: Our doctors have started prescribing a form of filgrastim that the pharmacy tells me is called a biosimilar. Do I report this with the HCPCS code for filgrastim, HCPCS code C9399 (unclassified drugs or biologicals), or some other code?
A: Biosimilars are relatively new in the industry, with the first being approved by the FDA on March 6, 2015. This first one happens to be for filgrastim.
A biosimilar is a product that is approved under an abbreviated application because it is similar to another biological product that is already approved and licensed under the Public Health Service Act.  The FDA has specific requirements for this process and the product must be very similar in the active components to the approved biological, as well has no differences in the safety, purity, and potency when compared to the approved biological. 
CMS has published a specific HCPCS code for the new biosimilar, which should be used to report this product. The code is Q5101 (injection, filgrastim (G-CSF), biosimilar, 1 microgram). For more information, see the FDA website.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Revant Solutions,in Fort Lauderdale, Florida, answered this question.

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