Billing codes
For your convenience, the billing codes for ZARXIO are as follows:
HCPCS Codes1 Five-digit alpha-numeric codes used to report drugs and other supplies |
Physician Office or Hospital Outpatient Setting2: Q5101 Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram1 |
CPT Codes3 Five-digit codes that describe procedures and services performed by physicians and other healthcare providers |
Physician Office or Hospital Outpatient Setting4: 96372—Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular |
Diagnosis Codes Numeric classification descriptive of patient conditions accepted by all payers |
Physician Office or Hospital Outpatient Setting: Appropriate ICD-9-CM or ICD-10-CM diagnosis code for the patient’s condition Allowable diagnosis codes vary by payer. Report the appropriate diagnosis code(s) to describe the patient’s condition. Primary and secondary diagnosis codes may be required. Use ICD-9-CM code(s) for dates of service prior to October 1, 2015 |
NDCs* Universal 11-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size |
Physician Office or Hospital Outpatient Setting: ZARXIO single-dose pre-filled syringe (PFS), pack of 1 PFS: |
*When reporting the NDC on claims, use the 5-4-2 digit format. Insert a leading zero in the appropriate section to complete the 5-4-2 digit format. Remove the dashes prior to entering the NDC on the claim form.
References: 1. US Centers for Medicare & Medicaid Services. Pub 100-04 Medicare Claims Processing: HCPCS Drug/Biological Code Changes. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R3966CP.pdf. Published February 2, 2018. Effective April 1, 2018. Accessed February 21, 2018. 2. Centers for Medicare & Medicaid Services. Part B biosimilar biological product payment and required modifiers. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/Part-B-Biosimilar-Biological-Product-Payment.html. Accessed May 3, 2017. 3. American Medical Association. CPT® process - how a code becomes a code. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-process-faq/code-becomes-cpt.page. Accessed May 3, 2017. 4. Centers for Medicare & Medicaid Services. CMS’ preliminary decisions on the recommendations of the hospital outpatient payment panel on supervision levels for select services. https://www.cms.gov/regulations-and-guidance/guidance/faca/downloads/prelim-supervision-decisions092412.pdf. Accessed May 3, 2017.
Please see information on ZARXIO administration on the next page.
ZARXIO is a registered trademark of Novartis AG.