AHA Coding Clinic® for HCPCS - 2016 Quarter 2; For Your Information
Required modifiers for biosimilar biological products
A biosimilar biological product is a biologic medical product that is almost an identical copy of an original product manufactured by a different company. CMS has issued HCPCS codes and modifiers for these biosimilar biological products. As a reminder, under the OPPS biosimilar biological products are required to include a modifier that identifies the manufacturer of the specific product. The modifier does not affect payment determination, but is used to distinguish between biosimilar products that appear in the same HCPCS code but are made by different manufacturers. The table below lists the current biosimilar HCPCS codes, the product(s) that...
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Article Overview
This article covers CMS guidance on biosimilar biological products under OPPS, focusing on the HCPCS coding framework and the manufacturer-identifying modifiers associated with current biosimilar products. It is relevant to coders, billing staff, and compliance teams who need to understand how these products are distinguished in claims and what code-level details CMS has published. The article presents a compact reference table with code effective dates and modifier effective dates.
Why This Topic Matters
Biosimilar reporting can depend on CMS-published HCPCS code assignments and required manufacturer identifiers, so accurate reference information helps support consistent billing and compliance workflows.
What You Will Learn
- How CMS organizes biosimilar biological product reporting in HCPCS
- Why manufacturer-specific modifiers are associated with these products
- What code and modifier details are presented in the current reference table
- How effective dates are included alongside the listed biosimilar product information
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Outpatient hospital coders
Codes Discussed
Modifiers Discussed
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