Billing & Coding
Billing & Coding
Prior Authorization and Appeals Assistance
Product Access
The information below provides billing and coding information and guides.
In physicians’ offices and hospital outpatient department sites of care, Medicare Administrative Contractors (MACs), private commercial payers, and Medicaid may recognize the following codes for reporting a biosimilar on claim forms.
Q5110
Q5110
Q5122
Q5105
Q5106
Q5119
Q5116
Q5118
Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 microgram
Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 mg
Injection, pegfilgrastim-apgf, biosimilar, (NYVEPRIA), 0.5 mg
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for ESRD on dialysis), 100 units
Injection, epoetin alfa-epbx, biosimilar, (RETACRIT) (for non-ESRD use), 1,000 units
Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg
Injection, trastuzumab-qyyp, biosimilar, (TRAZIMERA), 10 mg
Injection, bevacizumab-bvzr, biosimilar, (ZIRABEV), 10 mg
*The information provided here is intended for informational purposes only and is not a comprehensive description of potential coding requirements for the Pfizer Oncology product. Coding and coverage policies change periodically and often without warning. The healthcare professional is solely responsible for determining coverage and reimbursement parameters and accurate and appropriate coding for treatment of his/her own patients. The information provided in this section should not be considered a guarantee of coverage or reimbursement.
The sample form is intended as a reference for billing and coding of the Pfizer Oncology product. This form is not intended to be directive or to replace clinical decision-making, and the use of the recommended codes does not guarantee reimbursement. Healthcare professionals may deem other codes or policies more appropriate and should select the coding options that most accurately reflect their internal guidelines, payer requirements, practice requirements, practice patients, and the services rendered.
We’ll coordinate with a patient’s insurer to determine the PA requirements, where and how to submit requests, and typical turnaround times. After your office submits a PA request, we’ll follow up with the insurer on behalf of the patient to track the progress and status, upon your request.
Patient Access Navigators may be able to help address specific access issues—in person or over the phone. They can help provide education about access and reimbursement resources and can help address Pfizer Oncology patient cases you have sent to Pfizer Oncology Together.
ConnectA guide for healthcare providers on patient access and reimbursement support services through Pfizer Oncology Together.
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