HCPCS code Q5101
Medicare claims submitted containing a Q5101 Injection, Filgrastim (G-CSF),Biosimilar, 1 microgram with dates of service on or after Sept. 3, 2015, that were processed prior to the installation of the October 2015 Outpatient Prospective Payment System Pricer(OPPSP), request can be made for those claims to be adjusted by the Medicare Administrative Contractors.
The Centers for Medicare & Medicaid Services (CMS) notified Medicare administrative contractors (MAC) in Transmittal 3352 of this change, and it is in the October update of the Integrated Outpatient Code Editor (I/OCE) which reflects the Healthcare Common Procedure Coding System(HCPCS), Ambulatory Payment Classification(APC), HCPCS Modifier and Revenue Code Additions, changes and deletions identified in CR9298.
Effective Sept. 3, 2015, the status indicator for HCPCS Level II code Q5101 Injection, Filgrastim (G-CSF), Biosimilar, 1 microgram has changed from E Not paid by Medicare when submitted on outpatient claims or any outpatient bill type to K Paid under Outpatient Prospective Payment System OPPS; separate Ambulatory Payment Classification (APC) payment.
This change is effective Oct. 1, 2015.