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CMS Transmittals



IMPORTANT NOTICE: Updated W-9 for new address 3/1/18 available here.


Q5101
Quick jump to procedure code: Printer Friendly Version
Q9950

Procedure Category: HCPC Level II Codes
Procedure Subcategory: Temporary Codes

Q5102: Inj., infliximab biosimilar

HCPCS
Q5102: Injection, infliximab, biosimilar, 10 mg


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2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2018 OPPS Status Indicator: G

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

Q5102 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New


2018 Medically Unlikely Edits for Q5102

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: Not Listed Not Listed Not Listed
Adjudication Indicator: Not Listed Not Listed Not Listed
Rationale: Not Listed Not Listed Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.




   Medicare Part B Utilization Data for Q5102*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 267,572
Total Services Denied 2017: 10,434 (3.9%)
National Charges Submitted 2017: $ 45,248,336.59
National Charges Allowed 2017: $ 21,650,640.31
National Average (No Modifier) Fee Submitted 2017: $104.44
National Average (No Modifier) Fee Allowed 2017: $ 0.00


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Rheumatology
(eff 5/92)
173,407 64.8% $153.94 5,117 3.0%
Hematology/oncology
(eff 5/92)
41,416 15.5% $213.40 1,639 4.0%
Internal medicine 22,718 8.5% $183.12 1,194 5.3%
Medical oncology
(eff 5/92)
12,128 4.5% $190.40 942 7.8%
Gastroenterology 9,780 3.7% $155.08 370 3.8%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 267,512 100.0% $169.09 10,434 3.9%
Independent Clinic 60 0.0% $227.11 0 0.0%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
ZB 260,706 97.4% $167.78 9,768 3.7%
ZC 4,445 1.7% $209.12 321 7.2%
JW 1,196 0.4% $224.09 49 4.1%
76 - Repeat Procedure by Same Physician 538 0.2% $255.00 129 24.0%
AQ 390 0.1% $300.00 30 7.7%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

CMS Transmittals Referencing "Q5102"
Issue DateTransmittalTitle
2018-03-21 R4006CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1
2018-03-20 R4005CP April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2018-03-09 R3996CP April 2018 Update of the Ambulatory Surgical Center (ASC) Payment System
2018-03-07 R3997CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update
2018-03-02 R3988CP April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2018-03-02 R3989CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1
2018-02-16 R3976CP Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2018 Update
2018-02-02 R3966CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update
2018-01-12 R3950CP 2018 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List
20174-03-10 R3735CP April 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.1
2017-11-03 R3907CP October 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.3
2017-09-15 R3864CP October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2017-09-01 R3854CP October 2017 Update of the Ambulatory Surgical Center (ASC) Payment System
2017-08-25 R3850CP Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2017 Update
2017-08-25 R3853CP October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2017-03-03 R3728CP April 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
2017-01-05 R3689CP 2017 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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09/25/2018 04:07:17 54.162.159.33

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