Oncology & Hematology Coding Alert

Effective July 2015, submit level II HCPCS code Q5101 for biosimilar Zarxio.

Get ready to report a specific HCPCS code for Zarxio — sooner than you think. Transmittal R3254CP for reimbursement of Zarxio claims will be implemented July 6, 2015. Find out what lies ahead for you for your Zarxio claims. 

Zarxio is a biosimilar filgrastim, a human granulocyte colony stimulating factor (G-CSF). G-CSF regulates the production of a type of white blood cells, neutrophils, within the bone marrow. G-CSF influences the development and functional maturation of neutrophils by regulating neutrophil progenitor proliferation, differentiation, and selected end-cell functional activation. 

Your physician will calculate the required amount of filgrastim depending upon the body weight of the patient and the condition which is being treated. 

The recommended doses are as follows: 

5 mcg/kg/day: For cancer receiving myelosuppressive chemotherapy or induction and/or consolidation chemotherapy for AML, and for patients with cyclic idiopathic neutropenia; 

6 mcg/kg/day: Congenital neutropenia; and 

10 mcg/kg/day: Cancer undergoing bone marrow transplantation. 

Check Your Claims for Zarxio

Effective July 2015, submission of HCPCS code Q5101 (Injection, Filgrastim [G-CSF], Biosimilar, 1 microgram) is reported for every one (1) microgram of Zarxio administered. 

Why a specific code for Zarxio? Currently there are no existing HCPCS codes that describe Zarxio. Since Zarxio is a biosimilar product, it “must be separated” via HCPCS coding. Unique codes for biosimilar products are important as biosimilar products are single source drugs.

For claims with dates of service March 6, 2015, through June 30, 2015, you can submit claims for Zarxio injection using the Not Otherwise Classified (NOC) HCPCS code J3490 (Unclassified drugs) or J3590 (Unclassified biologics). 

You should submit claims for HCPCS codes J3490 and/or J3590 with additional qualifying information. Your claims must include:

• The name of the drug

• The National Drug Code (NDC) number 

• The exact dosage given 

• If using the unlisted or new HCPCS code depending on the date of service, since the product is supplied in a single dose syringe, should there be wastage, and it is documented along with the administered amount, you may be able to charge for the wasted amount as well. (Refer to Medicare Pub 100-04, Chapter 17, Section 40 for accurate reporting.)

For electronic claims, you should complete Loop/Element 2400 SV101-7 for Not Otherwise Classified (NOC) codes. Submit the required documentation (name, NDC and dosage) in Loop/Element 2400 SV101-7. If you need any additional space, you may use Loop 2400 NTE 02 in addition to SV101-7. For paper claims, list the documentation in Item 19.

Confirm Physician Supervision

When submitting claims for Zarxio, filgrastim G-CSF biosimilar, specify that the drug was administered under direct supervision of the physician in the office (Part B) or hospital setting (Part A). If you submit claim specifying that the patient or caregiver administered this drug, the drug administration will be considered self-administered and will not be payable by CGS A/B MAC.

Read more on: http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/May-7-2015-DrugAgenda.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3254CP.pdf.