HCPCS Code Q5107

Official Description

Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg

Short Descr	Inj mvasi 10 mg
Related Drugs	MVASI
Coverage	Special coverage instructions apply
Pricing Indicator(s)	51 – Drugs
MPI	A – Not applicable, as HCPCS priced under one methodology
Processing Note	PUB. 100-4, CHAPTER 17.
BETOS	O1E – Other drugs
TOS Code(s)	1 – Medical care
Added Date	1/1/2019
Status Code	Excluded from Physician Fee Schedule by Regulation
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals
ASC Payment Indicator	Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE	230
MUE	Not applicable/unspecified.
OTS Orthotic	No

JZ	Zero drug amount discarded/not administered to any patient
JW	Drug amount discarded/not administered to any patient
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
KP	First drug of a multiple drug unit dose formulation
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
JA	Administered intravenously
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
UD	Medicaid level of care 13, as defined by each state
KQ	Second or subsequent drug of a multiple drug unit dose formulation
TB	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
GA	Waiver of liability statement issued as required by payer policy, individual case
JB	Administered subcutaneously
77	Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
JG	Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
LT	Left side (used to identify procedures performed on the left side of the body)
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZ	Item or service expected to be denied as not reasonable and necessary
RT	Right side (used to identify procedures performed on the right side of the body)
GW	Service not related to the hospice patient's terminal condition