Retired Local Coverage Article Billing and Coding

Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars

A52408

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Article ID
A52408
Article Title
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2022
Revision Ending Date
10/31/2022
Retirement Date
10/31/2022
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CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article contains billing and coding guidelines that complement the Local Coverage Determination (LCD) Drugs and Biologicals, Coverage of, for Label and Off-Label Uses.

Abstract:

Filgrastim is a human granculocyte colony stimulating factor (G-CSF), produced by recombinant DNA technology.

Pegfilgrastim is a covalent conjugate of recombinant methionyl human G-CSF and monomethoxypolyethylene glycol.

Filgrastim and pegfilgrastim are CSFs that act on hematopoietic cells by binding to specific cell surface receptors thereby stimulating proliferation, differentiation, commitment, and end cell functional activation.

G-CSF regulates the production of neutrophils in the bone marrow. Neutrophils are essential in the body's fight against infections.

Tbo-filgrastim is a non-glycosylated recombinant methionyl human granulocyte colony-stimulating growth factor (r-metHuG-CSF) manufactured by recombinant DNA technology using the bacterium strain E coli K802.

Utilization:

Dose and frequency should be in accordance with the FDA label or recognized compendia (for off-label uses). When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Coding Information:

When filgrastim and biosimilars are used for febrile neutropenia, neutropenia of eclampsia or neutropenia associated with HIV disease, both a primary and a secondary diagnosis is required. Please see primary and secondary diagnosis tables located in the "ICD-10 Codes that are Covered" section.

There is a separate diagnosis listing for filgrastim and biosimilars when used for all other conditions. Only a single diagnosis is required.

Only the following ICD-10-CM codes, C64.1, C64.2, D61.810, D70.1, T45.1X5A - T45.1X5S, T66.XXXA, T66.XXXD, T66.XXXS, Z41.8, Z48.290, Z51.11, Z51.12, Z51.89, Z52.001, Z52.011, Z52.091, Z76.89, Z91.89, Z94.81 and Z94.84, support medical necessity for pegfilgrastim and biosimilars.

FDA and Compendia Review:

American Society of Health-System Pharmacists, Inc. AHFS Drug Information®. Bethesda, MD: 2007.

Clinical Pharmacology Web site. http://www.clinicalpharmacology.com/. Accessed 09/05/2022.

FDA label for filgrastim-sndz (Zarxio™). FDA Web site Accessed on 03/16/2015

FDA label for Tbo-filgrastim (Granix™). FDA Web site Accessed 01/08/2014.

FDA label for pegfilgrastim-jmdb, (Fulphila™). FDA Web site. Accessed on 08/24/2018.

FDA label for filgrastim-aafi, (Nivestym™). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761080s000lbl.pdf. Accessed 08/24/2018.

FDA label for pegfilgrastim-cbqv, (Udenyca™). FDA Website Accessed 12/12/2018.  

FDA label for pegfilgrastim-bmez, (Ziextenzo). https://www.accessdata.fda.gov/scripts/cder/daf/.  Accessed 11/8/2019.

FDA label for pegfilgrastim-apgf (Nyvepria™). FDA Web site. Accessed 12/9/2020.

Lexi-Drugs Web site. http://online.lexi.com. Accessed 09/05/2022. 

Micromedex DrugDex®. http://www.thomsonhc.com/home/dispatch. Accessed 09/05/2022.

National Comprehensive Cancer Network Web site. http://www.nccn.org/index.asp. Accessed 09/05/2022.

Coding Information

CPT/HCPCS Codes

Group 1

(10 Codes)
Group 1 Paragraph

Effective for dates of service on or after 10/01/2022, HCPCS code Q5125 should be used to report filgrastim-ayow for Part A and Part B services. For dates of service 07/01/2022 through 09/30/2022, HCPCS code C9096 should be used to report filgrastim-ayow for Part A services. For dates of service 02/25/2022 through 06/30/2022 HCPS code J3590 should be used to report Part A services. For dates of service 02/25/2022 through 09/30/2022, HCPCS code J3590 should be used to report Part B services.

Effective for dates of service on or after 01/01/2021, HCPCs code Q5122 should be used to report pegfilgrastim-apgf. For dates of service 6/10/2020 through 12/31/2020, HCPCS code J3590 should be reported.

Effective for dates of service on or after 07/01/2020, HCPCs code Q5120 should be used to report pegfilgrastim-bmez. Effective for dates of service prior to 7/1/2020 HCPCS code C9058 should be used for Part A services.

Group 1 Codes
CodeDescription
J1442 INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM
J1447 INJECTION, TBO-FILGRASTIM, 1 MICROGRAM
J2506 INJECTION, PEGFILGRASTIM, EXCLUDES BIOSIMILAR, 0.5 MG
J3590 UNCLASSIFIED BIOLOGICS
Q5101 INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM
Q5108 INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG
Q5110 INJECTION, FILGRASTIM-AAFI, BIOSIMILAR, (NIVESTYM), 1 MICROGRAM
Q5111 INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, (UDENYCA), 0.5 MG
Q5120 INJECTION, PEGFILGRASTIM-BMEZ, BIOSIMILAR, (ZIEXTENZO), 0.5 MG
Q5122 INJECTION, PEGFILGRASTIM-APGF, BIOSIMILAR, (NYVEPRIA), 0.5 MG

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(22 Codes)
Group 1 Paragraph

The ICD-10-CM codes listed below support medical necessity for pegfilgrastim and biosimilars.   

Group 1 Codes
CodeDescription
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
D61.810 Antineoplastic chemotherapy induced pancytopenia
D70.1 Agranulocytosis secondary to cancer chemotherapy
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5D Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T66.XXXA Radiation sickness, unspecified, initial encounter
T66.XXXD Radiation sickness, unspecified, subsequent encounter
T66.XXXS Radiation sickness, unspecified, sequela
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z48.290 Encounter for aftercare following bone marrow transplant
Z51.11 Encounter for antineoplastic chemotherapy
Z51.12 Encounter for antineoplastic immunotherapy
Z51.89 Encounter for other specified aftercare
Z52.001 Unspecified donor, stem cells
Z52.011 Autologous donor, stem cells
Z52.091 Other blood donor, stem cells
Z76.89 Persons encountering health services in other specified circumstances
Z91.89 Other specified personal risk factors, not elsewhere classified
Z94.81 Bone marrow transplant status
Z94.84 Stem cells transplant status

Group 2

(4 Codes)
Group 2 Paragraph

The ICD-10-CM codes listed below support the medical necessity of filgrastim and biosimilars when used for febrile neutropenia, neutropenia of eclampsia or neutropenia associated with HIV disease. Note that claims require both a primary (from Group 2) and a secondary diagnosis (from Group 3).

Primary Diagnosis


Group 2 Codes
CodeDescription
D70.3 Neutropenia due to infection
D70.9 Neutropenia, unspecified
D72.818 Other decreased white blood cell count
D72.819 Decreased white blood cell count, unspecified

Group 3

(21 Codes)
Group 3 Paragraph

Secondary Diagnosis

Group 3 Codes
CodeDescription
B20 Human immunodeficiency virus [HIV] disease
O14.00 Mild to moderate pre-eclampsia, unspecified trimester
O14.02 Mild to moderate pre-eclampsia, second trimester
O14.03 Mild to moderate pre-eclampsia, third trimester
O14.04 Mild to moderate pre-eclampsia, complicating childbirth
O14.05 Mild to moderate pre-eclampsia, complicating the puerperium
O14.12 Severe pre-eclampsia, second trimester
O14.13 Severe pre-eclampsia, third trimester
O14.14 Severe pre-eclampsia complicating childbirth
O14.15 Severe pre-eclampsia, complicating the puerperium
O14.22 HELLP syndrome (HELLP), second trimester
O14.23 HELLP syndrome (HELLP), third trimester
O14.24 HELLP syndrome, complicating childbirth
O14.25 HELLP syndrome, complicating the puerperium
O14.90 Unspecified pre-eclampsia, unspecified trimester
O14.92 Unspecified pre-eclampsia, second trimester
O14.93 Unspecified pre-eclampsia, third trimester
O14.94 Unspecified pre-eclampsia, complicating childbirth
O14.95 Unspecified pre-eclampsia, complicating the puerperium
O15.2 Eclampsia complicating the puerperium
R50.81 Fever presenting with conditions classified elsewhere

Group 4

(133 Codes)
Group 4 Paragraph

The ICD-10-CM codes listed below support the medical necessity of filgrastim and biosimilars for indications not listed above in the Group 2 paragraph. 

Group 4 Codes
CodeDescription
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C88.2 Heavy chain disease
C88.3 Immunoproliferative small intestinal disease
C88.8 Other malignant immunoproliferative diseases
C88.9 Malignant immunoproliferative disease, unspecified
C90.10 Plasma cell leukemia not having achieved remission
C90.11 Plasma cell leukemia in remission
C90.20 Extramedullary plasmacytoma not having achieved remission
C90.21 Extramedullary plasmacytoma in remission
C90.30 Solitary plasmacytoma not having achieved remission
C90.31 Solitary plasmacytoma in remission
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.01 Acute lymphoblastic leukemia, in remission
C91.02 Acute lymphoblastic leukemia, in relapse
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.11 Chronic lymphocytic leukemia of B-cell type in remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
C91.30 Prolymphocytic leukemia of B-cell type not having achieved remission
C91.31 Prolymphocytic leukemia of B-cell type, in remission
C91.32 Prolymphocytic leukemia of B-cell type, in relapse
C91.40 Hairy cell leukemia not having achieved remission
C91.41 Hairy cell leukemia, in remission
C91.42 Hairy cell leukemia, in relapse
C91.50 Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission
C91.51 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission
C91.52 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse
C91.60 Prolymphocytic leukemia of T-cell type not having achieved remission
C91.61 Prolymphocytic leukemia of T-cell type, in remission
C91.62 Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 Mature B-cell leukemia Burkitt-type not having achieved remission
C91.A1 Mature B-cell leukemia Burkitt-type, in remission
C91.A2 Mature B-cell leukemia Burkitt-type, in relapse
C91.Z0 Other lymphoid leukemia not having achieved remission
C91.Z1 Other lymphoid leukemia, in remission
C91.Z2 Other lymphoid leukemia, in relapse
C91.90 Lymphoid leukemia, unspecified not having achieved remission
C91.91 Lymphoid leukemia, unspecified, in remission
C91.92 Lymphoid leukemia, unspecified, in relapse
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.01 Acute myeloblastic leukemia, in remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.11 Chronic myeloid leukemia, BCR/ABL-positive, in remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.21 Atypical chronic myeloid leukemia, BCR/ABL-negative, in remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.30 Myeloid sarcoma, not having achieved remission
C92.31 Myeloid sarcoma, in remission
C92.32 Myeloid sarcoma, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.41 Acute promyelocytic leukemia, in remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.51 Acute myelomonocytic leukemia, in remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.61 Acute myeloid leukemia with 11q23-abnormality in remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C92.Z0 Other myeloid leukemia not having achieved remission
C92.Z1 Other myeloid leukemia, in remission
C92.Z2 Other myeloid leukemia, in relapse
C92.90 Myeloid leukemia, unspecified, not having achieved remission
C92.91 Myeloid leukemia, unspecified in remission
C92.92 Myeloid leukemia, unspecified in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C94.00 Acute erythroid leukemia, not having achieved remission
C94.02 Acute erythroid leukemia, in relapse
C94.20 Acute megakaryoblastic leukemia not having achieved remission
C94.22 Acute megakaryoblastic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.41 Acute panmyelosis with myelofibrosis, in remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
D47.1 Chronic myeloproliferative disease
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
D47.9 Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified
D61.1 Drug-induced aplastic anemia
D61.2 Aplastic anemia due to other external agents
D61.3 Idiopathic aplastic anemia
D61.810 Antineoplastic chemotherapy induced pancytopenia
D61.811 Other drug-induced pancytopenia
D61.818 Other pancytopenia
D61.82 Myelophthisis
D61.89 Other specified aplastic anemias and other bone marrow failure syndromes
D70.0 Congenital agranulocytosis
D70.1 Agranulocytosis secondary to cancer chemotherapy
D70.2 Other drug-induced agranulocytosis
D70.4 Cyclic neutropenia
D70.8 Other neutropenia
D70.9 Neutropenia, unspecified
K12.31 Oral mucositis (ulcerative) due to antineoplastic therapy
K12.33 Oral mucositis (ulcerative) due to radiation
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5D Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T66.XXXA Radiation sickness, unspecified, initial encounter
T66.XXXD Radiation sickness, unspecified, subsequent encounter
T66.XXXS Radiation sickness, unspecified, sequela
T80.82XA Complication of immune effector cellular therapy, initial encounter
T80.82XS Complication of immune effector cellular therapy, sequela
T80.89XA Other complications following infusion, transfusion and therapeutic injection, initial encounter
T80.89XS Other complications following infusion, transfusion and therapeutic injection, sequela
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z48.290 Encounter for aftercare following bone marrow transplant
Z51.11 Encounter for antineoplastic chemotherapy
Z51.12 Encounter for antineoplastic immunotherapy
Z51.89 Encounter for other specified aftercare
Z52.001 Unspecified donor, stem cells
Z52.011 Autologous donor, stem cells
Z52.091 Other blood donor, stem cells
Z76.82 Awaiting organ transplant status
Z76.89 Persons encountering health services in other specified circumstances
Z91.89 Other specified personal risk factors, not elsewhere classified
Z94.81 Bone marrow transplant status
Z94.84 Stem cells transplant status

Group 5

(33 Codes)
Group 5 Paragraph

The ICD-10-CM codes listed below support medical necessity for Tbo-filgrastim

Group 5 Codes
CodeDescription
C93.10 Chronic myelomonocytic leukemia not having achieved remission
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.4 Refractory anemia, unspecified
D46.Z Other myelodysplastic syndromes
D46.9 Myelodysplastic syndrome, unspecified
D61.810 Antineoplastic chemotherapy induced pancytopenia
D61.811 Other drug-induced pancytopenia
D61.818 Other pancytopenia
D70.1 Agranulocytosis secondary to cancer chemotherapy
D70.3 Neutropenia due to infection
D70.8 Other neutropenia
D70.9 Neutropenia, unspecified
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5D Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T66.XXXA Radiation sickness, unspecified, initial encounter
T66.XXXD Radiation sickness, unspecified, subsequent encounter
T66.XXXS Radiation sickness, unspecified, sequela
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z48.290 Encounter for aftercare following bone marrow transplant
Z51.11 Encounter for antineoplastic chemotherapy
Z51.12 Encounter for antineoplastic immunotherapy
Z51.89 Encounter for other specified aftercare
Z52.011 Autologous donor, stem cells
Z76.89 Persons encountering health services in other specified circumstances
Z91.89 Other specified personal risk factors, not elsewhere classified
Z94.81 Bone marrow transplant status
Z94.84 Stem cells transplant status

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/31/2022 R26

This article will no longer be in effect for services performed after 10/31/2022. Please refer to article A59218 Off-Label Use of Drugs and Biologicals for Anti-Cancer Chemotherapeutic Regimen.

10/01/2022 R25

Based on the annual ICD-10 code update, the descriptor for ICD-10 code C94.6 was changed in Group 4. Based on Transmittal 11594, (CR 12885) October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS), HCPCS code Q5125 has been added to the CPT/HCPCS Codes paragraph section of the article.

07/01/2022 R24

Deactivated link in the "Article Text" section of the article. 

07/01/2022 R23

Based on Transmittal 11435 (CR 12761) July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS) – HCPCS code C9096 has been added to the CPT/HCPCS Codes paragraph section of the article.

04/01/2022 R22

Deactivated all links in the "Article Text" section of the article. 

04/01/2022 R21

Based on compendia review, ICD-10 codes T80.82XA, T80.82XS, T80.89XA and T80.89XS have been added to Group 4 ICD-10 code list effective for dates of service on or after 04/01/2022.

01/01/2022 R20

Based on the annual CPT/HCPCS update, HCPCS code J2506 has been added to the "CPT/HCPCS Codes” section of the article and will replace deleted HCPCS code J2505.

05/01/2021 R19

Based on compendia review, ICD-10 codes C64.1 and C64.2 have been added to the Group 1 and Group 4 ICD-10 code lists for pegfilgrastim and biosimilars and filgrastim and biosimilars effective for dates of service on or after 05/01/2021.

01/01/2021 R18

HCPCS code Q5122 has been added to the "CPT/HCPCS Codes" section.  

01/01/2021 R17

Based on the annual HCPCS update, HCPCS code Q5122 has been added to the "CPT/HCPCS Codes Paragraph" section of the article.

08/01/2020 R16

Based on Transmittal 10196 (CR 11792 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update), - C9058 has been deleted and replaced with HCPCS code Q5120 to report pegfilgrastim-bmez. Outdated information has been removed.

04/01/2020 R15

Based on Transmittal 4543, HCPCS code C9058 has been added to the “CPT/HCPCS Codes Group 1 Paragraph” section and the CPT/HCPCS section of the article to report pegfilgrastim-bmez for Part A services.

01/01/2020 R14

Pegfilgrastim-bmez has been added to the article effective for dates of service on or after 11/4/2019. HCPCS code J3590 has been added to the Group 1 "CPT/HCPCS Codes" section to report pegfilgrastim-bmez. Pegfilgrastim-bmez has also been added to the Group 1 paragraph in the “ICD-10 Codes that Support Medical Necessity” section. Based on compendia review, ICD-10-CM codes D61.810, D61.811 and D61.818 have been added to Group 5 for Tbo-filgrastim effective for dates of service on or after 01/01/2020. Based on the annual CPT/HCPCS update, the description for Q5111 has been revised.

11/07/2019 R13

This article was converted to the new Billing and Coding Article format. The Article Text section has been revised to remove the indications which can be found on the FDA Web site and in the approved compendia. The “Sources of Information” has been revised to “FDA and Compendia Review.” Sources of information other than the FDA and compendia have been moved to a PDF file attached to LCD L33394. The Bill type codes have been removed from this article. Guidance on these codes is available in the Bill type code section.

08/01/2019 R12

Based on compendia review, the following updates have been made. The indications below have been added for filgrastim, filgrastim-sndz and filgrastim-aafi:

  • for patients who present with acute exposure to myelosuppressive doses of radiation
  • hematopoietic cell transplant for
      • mobilization of hematopoietic progenitor cells in combination with plerixafor in the autologous setting for patients with non-Hodgkin lymphoma or multiple myeloma
      • mobilization of donor hematopoietic progenitor cells (preferred) or for granulocyte transfusion in the allogeneic setting
      • supportive care in the post-transplant setting

ICD-10-CM codes T66.XXXA, T66.XXXD and T66.XXXS have been added to Group 4 for filgrastim, filgrastim-sndz and filgrastim-aafi effective for dates of service on or after 08/01/2019.

The following indication has been added for Tbo-filgrastim:

  • for patients who present with acute exposure to myelosuppressive doses of radiation

ICD-10-CM codes T66.XXXA, T66.XXXD and T66.XXXS have been added to Group 5 for Tbo-filgrastim effective for dates of service on or after 08/01/2019.

01/01/2019 R11

Based on the 2019 annual HCPCS update, HCPCS code Q5111 for pegfilgrastim-cbqv, has been added to the “CPT/HCPCS Codes Group 1 Paragraph” section of the article. Pegfilgrastim-cbqv has been added to the Group 1 Paragraph in the “ICD-10 Codes that are Covered” section and throughout the article.

10/01/2018 R10

Based on Transmittal 4134, HCPCs code Q5108 has been added for pegfilgrastim-jmdb effective for dates of service on or after July 12, 2018 and HCPCs code Q5110 has been added for filgrastim-aafi effective for dates of service on or after 10/01/2018. References to pegfilgrastim-jmdb and filgrastim aafi have been added throughout the article.

07/15/2018 R9

ICD-10-CM code Z51.12 has been added to Group 5 for Tbo-filgrastim effective for dates of service on or after 07/15/2018.

04/01/2018 R8

Based on Transmittal 3966 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update, the description for HCPCS code Q5101 has changed and use of the ZA modifier has been discontinued effective 04/01/2018.

ICD-10-CM codes Z48.290 and Z94.81 have been added to the Group 1 codes for pegfilgrastim effective for dates of service on or after 05/03/2018. ICD-10-CM codes C93.00, C93.02, C93.10, C94.00, C94.02, C94.20 and C94.22 have been added to the Group 4 codes for filgrastim effective for dates of service on or after 05/03/2018. An indication for anemia in myelodysplastic syndrome; in combination with epoetin has been added to the “Indications” section for Tbo-filgrastim. ICD-10-CM codes C93.10, D46.0, D46.1, D46.20, D46.21, D46.A, D46.B, D46.4, D46.Z, D46.9, Z48.290 and Z94.81 have been added to the Group 5 codes for Tbo-filgrastim effective for dates of service on or after 05/03/2018.

10/01/2016 R7 Based on the annual ICD-10-CM code update, ICD-10-CM codes O14.04, O14.05, O14.14, O14.15, O14.24, O14.25, O14.94 and O14.95 have been added to the Group 3 Codes. The descriptor for ICD-10-CM code O15.2 was changed.
09/01/2016 R6 The “Indications” for pegfilgrastim have been revised to include:
  • to increase survival in patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Subsyndrome of Acute Radiation Syndrome). (Effective 11/13/2015 based on FDA approval)
  • supportive care in the posttransplant setting
ICD-10-CM codes T66.XXXA, T66.XXXD and T66.XXXS have been added effective for dates of service on or after 11/13/2015 and ICD-10-CM codes Z52.001, Z52.011 and Z52.091 have been added effective for dates of service on or after 09/01/2016. The “Indications” for filgrastim have been revised to include filgrastim-sndz and the separate listing for filgrastim-sndz has been removed.
06/01/2016 R5 The “Indications” for Tbo-filgrastim have been clarified to indicate hematopoietic cell transplant for supportive care in the post-transplant setting. ICD-10-CM code D70.2 has been added to the Group 4 codes for filgrastim and filgrastim-sndz retroactive to 10/01/2015.
06/01/2016 R4 The “Indications” for Tbo-filgrastim have been revised to include:
  • in mobilization of hematopoietic progenitor cells in the autologous setting as a single agent, following combination chemotherapy, or in combination with plerixafor when the transplant procedure is a covered benefit
  • supportive care in the post-transplant setting
ICD-10-CM codes Z52.011 and Z94.84 have been added for Tbo-filgrastim effective for dates of service on or after 06/01/2016. The first paragraph in the "Indications" section of the article has been revised to include Lexi-Drug compendium. Lexi-Drug Web site has been added to the “Sources of Information” section of the article.
01/01/2016 R3 Based on the annual HCPCS update for 2016, HCPCS code J1446 has been deleted and replaced with J1447 and the description for J1442 has changed. The “Coding Information” section has been updated to include the following:
    Based on Transmittal 1542, HCPCS code Q5101 must be billed with modifier ZA to identify the manufacturer for biosimilar drugs. Effective for dates of service on or after 01/01/2016, HCPCS code Q5101 submitted without modifier ZA will be returned to the provider.

The following information has been added to the Group 1: Paragraph in the “CPT/HCPCS Codes” section:
    Effective for dates of service on or after 01/01/2016, HCPCS code Q5101 must be billed with modifier ZA

11/01/2015 R2 The article has been revised to add information for filgrastim-sndz throughout the article. HCPCs code Q5101 has been added to the “CPT/HCPCS Codes” section of the article. Filgrastim-sndz has been added to ICD-10-CM code groups 2, 3 and 4. ICD-10-CM code Z76.89 has been added to the ICD-10-CM code groups 1, 4 and 5 effective 10/1/2015. ICD-10-CM code Z76.89 has also been added to the third paragraph for pegfilgrastim in the “Coding Information” section.
10/01/2015 R1 The place of service guidelines for the Part B MAC have been removed. ICD-10-CM codes T45.1X5A, T45.1X5D and T45.1X5S have been added to ICD-10-CM code groups: Group 1:, Group 4: and Group 5:. ICD-10-CM codes T45.1X5A - T45.1X5S have been added to the list of codes that support medical necessity for pegfilgrastim in the "Coding Information" section and ICD-10-CM code D70.2 has been removed. ICD-10-CM code D70.2 has been removed from Group 1: Group 4: and Group 5:. The dosing information has been removed and replaced with the following Utilization guideline: Dose and frequency should be in accordance with the FDA label or recognized compendia (for off-label uses). When services are performed in excess of established parameters, they may be subject to review for medical necessity.

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