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Billing & Coding Information*

The information below provides billing and coding information and guides.

Pfizer Oncology Biosimilars Q Codes:

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.

HCPCS Code

Q5110
Q5122
Q5105
Q5106
Q5119
Q5116
Q5118

Descriptor

Injection, filgrastim-aafi, biosimilar, (NIVESTYM), 1 microgram
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.

Prior Authorization and Appeals Assistance

Prior Authorization (PA) Assistance

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.

Appeals Assistance

We can review the reasons for a denied claim and help with the appeals process by providing information on payer requirements, upon request.
Below are sample letters and checklists that may be helpful in cases where additional information is required by the insurer.†

Sample Letters

Checklists

†The information contained in these template letters is provided by Pfizer for informational purposes for patients prescribed a Pfizer medication. These templates are not intended to substitute for a prescriber’s independent medical decision-making.

Pharmacies and Distributors

To help your patients access the medication you’ve prescribed, Pfizer Oncology Together can identify the specialty distributors and specialty pharmacies available through our network.

Specialty Pharmacies

To help your patients access the medication you’ve prescribed, Pfizer Oncology Together can identify specialty pharmacy options through the patient’s plan, if needed. If you prefer, you and your staff can also continue to work directly with specialty pharmacies.

Product Access

Injectable biosimilars are available through most major wholesalers. For more information, please contact Pfizer Oncology Together at 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET).

Patient Access Navigators

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.
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Field Reimbursement Directors

Pfizer Oncology Field Reimbursement Directors (FRDs) can help navigate the access and reimbursement process—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.
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Looking for assistance?Red StarCall 1-877-744-5675Green StarMon–Fri, 8 AM–8 PM ETRed Star
Looking for assistance?Green StarCall 1-877-744-5675Red StarMon–Fri, 8 AM–8 PM ETGreen Star
Please see full Prescribing Information for ADCETRIS, including BOXED WARNING, or visit ADCETRIShcp.com.
Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.
Please see full Prescribing Information for DAURISMO, including BOXED WARNING and Medication Guide, or visit DAURISMOhcp.com.
Please see full Prescribing Information for ELREXFIO, including BOXED WARNING and Medication Guide, or visit ELREXFIOhcp.com.
Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.
Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.
Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.
Please see full Prescribing Information for SUTENT, including BOXED WARNING and Medication Guide, or visit SUTENThcp.com.
Please see full Prescribing Information for TIVDAK, including BOXED WARNING, or visit TIVDAKhcp.com.
Please see full Prescribing Information for TRAZIMERA, including BOXED WARNING, or visit TRAZIMERAhcp.com.

Looking for assistance?

Call 1-877-744-5675

(Monday–Friday 8 AM–8 PM ET)

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