Reimbursement of Biosimilars Without Q Codes
As a new biosimilar comes to market and until a Q code is assigned, CMS allows the use of a “not otherwise classified” code or unassigned codes in the interim. Dates of service before April 1, 2018, used the HCPCS code Q5102. To be reimbursed by CMS, the NDC must be in CMS’ Box 19, even if it is automatically entered on forms.
For questions regarding coding and reimbursements, send an email to email@example.com.
This information was taken from a webinar Best Practice Billing NOC and Unspecified Codes in November 2018.