J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-
Frequently asked questions about Epogen (epoetin alfa) Retacrit (epoetin alfa-epbx) is a biosimilar of Epogen (epoetin alfa) and Procrit (epoetin alfa). Epogen and Procrit are the original biologic medications. This means that Retacrit is very similar, but isn't identical.
HCPCS code Q5106 for Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units as maintained by CMS falls under Anti-Inflammatory Medication and Chemotherapy Medication.
HCPCS code J0885 for Injection, epoetin alfa, (for non-ESRD use), 1000 units as maintained by CMS falls under Drugs, Administered by Injection .
coding for the J0885 (Epogen, Procrit)
EPOGEN® is a prescription medicine for people on dialysis with anemia due to CKD that acts like a hormone called erythropoietin (ee-rith-row-PO-eh-tin). This hormone plays an important role in making red blood cells. EPOGEN® is used to treat anemia by helping the body create more red blood cells.
Epoetin alfa (Retacrit, Procrit, Epogen) is a glycoprotein that stimulates red blood cell production; whereas, darbepoetin alfa (Aranesp) stimulates erythropoiesis by the same mechanism as endogenous erythropoietin.
HCPCS code Q5108 for Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg as maintained by CMS falls under Anti-Inflammatory Medication and Chemotherapy Medication.
Providers must bill with HCPCS code: Q5107 - Injection, bevacizumab, (Mvasi), 10 mg. One Medicaid and NC Health Choice unit of coverage is: 10 mg The maximum reimbursement rate per unit is: $73.16. Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units.
J0881 and J0885 are intended for use for patients who are Non-ESRD and are not yet on dialysis. J0881 and J0885 are also intended for use with patients who meet the other indications outlined in the LCD. J0882 and J0886 are intended for use only with patients who are ESRD and on dialysis.
Medicare requires a modifier on the J0885 (either EA or EC depending on the indication) & our MAC carrier requires the reporting of the hemoglobin or hematocrit test result. If you're giving it for anemia caused by chemo and/or the neoplasm then use the EA modifier & list the D64. 81 first.
The RETACRIT HCPCS code Q5106 is described as “Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD on dialysis) 1,000 units.” Each dose increment of 1,000 Units equals 1 billing unit.