Medicare providers and suppliers that effective for claims with dates of service on or after July 1, 2016, new Healthcare Common Procedure Coding System (HCPCS) codes Q9981 (rolapitant, oral, 1mg); Q9982 (flutemetamol f18 diagnostic); and Q9983 (florbetaben f18 diagnostic) will be payable for Medicare. In addition, the HCPCS code set will contain code Q5102 (Inj., infliximab biosimilar), which is effective for dates of service on or after April 5, 2016. Claims for Q5102 must also have
the modifier ZB (Pfizer/hospira). Make sure that your billing staffs are aware of these changes.
The HCPCS code set is updated on a quarterly basis and CR9636 provides that effective July 1, 2016, the HCPCS codes contained in the following table will be established:
HCPCS Code Short Description Long Description Type of Service (TOS) Code
Q9981 rolapitant, oral, 1mg Rolapitant, oral, 1 mg 1
Q9982 flutemetamol f18 diagnostic Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries 4
Q9983 florbetaben f18 diagnostic Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries 4
Also, as of July 1, the HCPCS code set will contain code Q5102 (short descriptor – Inj., infliximab biosimilar – and long descriptor – Injection, Infliximab, 10 mg). Code Q5102 will be effective for dates of service on or after April 5, 2016, and will have TOS codes of 1 and P. In addition, claims for Q5102 must also have the modifier ZB (Pfizer/hospira).
