Comprehensive Support to Help Streamline Claims Approval
Announcing the CIMERLI® Permanent Q-Code
Effective April 1, 2023
A permanent, product-specific Q-code has been established for CIMERLI®Q5128 , Injection, ranibizumab-eqrn, biosimilar (CIMERLI), 0.1 mg
CMS has established a new, permanent Q-code for CIMERLI®, effective April 1, 2023. For dates of service on or after April 1, 2023, CIMERLI® should be reported with Q5128, and this code
should replace any miscellaneous codes previously used, such as J3490.
For dates of service prior to April 1, 2023, a miscellaneous code may still be required. Biosimilars receive permanent Q-codes, not J-codes.
0.5 mg: 5 billable units with NDC: 70114-0441-01 0.3 mg: 3 billable units with NDC: 70114-0440-01
For additional information regarding coding and billing or to
complete a benefit verification, please contact CIMERLI Solutions™
Coherus Solutions™ Offers Reimbursement
Solutions You Can Count On
Prior Authorization Support (PA): Coherus Solution™ offers ePA support to streamline and ease administrative burden
Coding and Billing Support: Sample coding and billing information is available to help facilitate appropriate claims submission*
Patient Financial Assistance: Coherus Solution™ can help address patient out-of-pocket cost concerns
Appeals Assistance: Coherus Solution™ provide assistance with appealing denied claims
Product Replacement: Coherus Solution™ can help with product spoilage
*Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Coherus does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
The CIMERLI® Coding Reference Guide is a one page coding guide with details that may help
facilitate appropriate billing and reimbursement for CIMERLI® therapy. The guide provides
information regarding HCPCS Codes, Modifiers, CPT Codes and ICD-10 information
Coherus’ Drug Copay Program and Administration Copay Program are different programs with unique eligibility for each. Patients must enroll separately as needed. To receive co-pay assistance for administration co-pay costs, the provider, patient, or caregiver must enroll eligible individual within 180 days after the date of service for which the subsidy is sought.
Participating patients, pharmacies, physician offices and hospitals may use Coherus’ patient services web portal or send completed enrollment forms to 1-877-226-6370 to enroll patients. Under the program, if a patient incurs a co-pay obligation for the administration of CIMERLI, and meets all eligibility requirements, Coherus shall subsidize the cost of administration up-to $1000 per calendar year. The program benefit will reset every January 1st. Re-enrollment in the program is required at regular intervals. Patients may participate in the program as long as patient re-enrolls as required by Coherus BioSciences and continues to meet all of the program’s eligibility requirements during participation in the program.. After reaching the maximum program benefit, the patient will be responsible for all remaining out-of-pocket expenses. The amount of the program’s benefits cannot exceed the patient’s out-of-pocket expenses for the cost of the drug or administration fees associated with CIMERLI.
The program is not valid if the costs are eligible to be reimbursed in their entirety by private insurance plans or other programs. The program is not valid for patients receiving assistance from any other third party, including charitable organizations, if assistance is for the same expenses covered by the programs. The administration assistance cannot be combined with any other rebate, free trial or similar offer for the medication or administration of the product unless otherwise permitted by Coherus. The program is not health insurance or a benefit plan.
All participants are responsible for reporting the receipt of all program benefits as required by any insurer or by law. The programs are only valid in the United States and U.S. Territories and otherwise void where prohibited by law, including in Minnesota, Rhode Island. *In Massachusetts special conditions apply. The injection administration copay may only be paid directly to the patient. Additional information may be required to facilitate payment directly to the patient. Program benefits may not be sold, purchased, traded or offered for sale.
The programs do not obligate use of any specific product or provider. Healthcare providers may not advertise or otherwise use the programs as a means of promoting their services or Coherus products to patients. Coherus reserves the right to rescind, revoke or amend the program without notice at any time.