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Explains how CMS HCPCS product-specific codes distinguish ESRD versus non-ESRD utilization, and outlines modifiers used to capture unused drug, anemia indications, hematocrit/hemoglobin status, and administration route requirements. Includes guidance that coding and reimbursement depend on payer policy, not guarantees, and provides patient support options such as benefits verification, PA assistance, and appeals support.",{"@graph":63,"@context":112},[64,80,95],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":21,"@type":70,"position":76},"https://docshare.wps.com/template/invoices/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/retacrit-billing-and-coding-guide-important-billing-and-coding-information/566893/",4,{"url":78,"name":59,"@type":81,"author":82,"headline":59,"publisher":85,"fileFormat":88,"inLanguage":57,"description":61,"dateModified":89,"datePublished":89,"encodingFormat":88,"isAccessibleForFree":90,"interactionStatistic":91},"DigitalDocument",{"name":83,"@type":84},"GGG","Person",{"url":68,"name":86,"@type":87},"DocShare","Organization","application/pdf","2026-10-13",true,{"@type":92,"interactionType":93,"userInteractionCount":4},"InteractionCounter",{"@type":94},"ViewAction",{"@type":96,"mainEntity":97},"FAQPage",[98,104,108],{"name":99,"@type":100,"acceptedAnswer":101},"What is the purpose of the RETACRIT Billing and Coding Guide?","Question",{"text":102,"@type":103},"It helps healthcare providers understand how to code and report RETACRIT (epoetin alfa-epbx) on claim forms. It also clarifies that coding and coverage policies can change and require provider responsibility for reimbursement decisions.","Answer",{"name":105,"@type":100,"acceptedAnswer":106},"How do HCPCS codes differ for ESRD versus non-ESRD use of RETACRIT?",{"text":107,"@type":103},"The guide states that CMS assigned different product-specific HCPCS codes to identify ESRD utilization compared with non-ESRD utilization. Providers must use the appropriate HCPCS code depending on the use case.",{"name":109,"@type":100,"acceptedAnswer":110},"What key modifiers may be used when billing RETACRIT?",{"text":111,"@type":103},"The guide describes modifiers tied to unused/discarded drug amounts, anemia due to chemotherapy or radiotherapy, hematocrit/hemoglobin thresholds, and route of administration for ESRD claims. 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Coding and coverage policies change periodically and often without notice. The HCP is solely responsible for determining coverage and reimbursement parameters and appropriate coding for treatment of his/her patients. The information provided should not be considered a guarantee of coverage or reimbursement for RETACRIT.  \nPlease see Important Safety Information and Indications on pages 14-16 and full Prescribing Information, including BOXED WARNINGS and Medication Guide.  \n2  \nMaking your patients’ support needs a priority. Together.  \nAt Pfizer Oncology Together, patient support is at the core of everything we do. We’ve gathered resources and developed tools to help patients and their loved ones throughout RETACRIT treatment. From helping to identify financial assistance options to connecting patients to resources for emotional support, your patients’ needs are our priority.*  \nBenefits Verification  \nWe can help determine a patient’s coverage and out-of-pocket costs.  \nPrior Authorization (PA) Assistance  \nWe can coordinate with a patient’s insurer to determine the PA requirements. After a PA request is submitted, we can follow up with the payer until a final outcome is determined.  \nAppeals Assistance  \nWe can review the reasons for a denied claim and provide information on payer requirements. After an appeal is submitted, we can follow up with the payer until a final outcome is determined.  \nBilling and Coding Assistance for Injectable Products  \nFor your patient claim submissions, we provide easy access to sample forms and template letters, along with billing and coding information for physician office and hospital outpatient settings of care.  \nPatient Financial Assistance  \nWe can help patients understand their benefits and connect them with financial assistance resources.  \nFOR LIVE, PERSONALIZED SUPPORT  \nCall 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET)  \nVISIT  \n[PfizerOncologyTogether.com](PfizerOncologyTogether.com)  \n*Some services are provided through third-party organizations that operate independently and are not controlled by Pfizer. Availability of services and eligibility requirements are determined solely by these organizations.  \nPlease see Important Safety Information and Indications on pages 14-16 and full Prescribing Information, including BOXED WARNINGS and Medication Guide.  \n3  \nCoding Overview  \nIn the physician office, hospital outpatient department, and dialysis sites of care, Medicare Administrative Contractors (MACs), private commercial payers, and Medicaid may recognize the following codes for reporting RETACRIT on claim forms. RETACRIT will be covered under the End-Stage Renal Disease (ESRD) Prospective Payment System for utilization in the dialysis setting.  \nCoding for RETACRIT  \nThe Centers for Medicare & Medicaid Services (CMS) assigned RETACRIT product-specific Healthcare Common Procedure Coding System (HCPCS) codes to identify ESRD and non-ESRD utilization of RETACRIT. The HCPCS code used to report RETACRIT is different for ESRD and non-ESRD use. HCPs may use the following HCPCS codes for all payers in all settings of care.1  \nHCPCS Code 1 Descriptor  \nQ5105 Injection, epoetin alfa-epbx, biosimilar,(Retacrit) (for ESRD on dialysis), 100 units  \n","cbCaibVy5EIUtxpc","https://ap.wps.com/l/cbCaibVy5EIUtxpc","pdf",1550510,"English","# Introduction\n# Benefits Verification\n# Prior Authorization (PA) Assistance\n# Appeals Assistance\n# Billing and Coding Assistance for Injectable Products\n# Patient Financial Assistance\n# Coding Overview\n## Coding for RETACRIT\n## HCPCS Code Descriptors and Modifiers","[{\"question\":\"What is the purpose of the RETACRIT Billing and Coding Guide?\",\"answer\":\"It helps healthcare providers understand how to code and report RETACRIT (epoetin alfa-epbx) on claim forms. It also clarifies that coding and coverage policies can change and require provider responsibility for reimbursement decisions.\"},{\"question\":\"How do HCPCS codes differ for ESRD versus non-ESRD use of RETACRIT?\",\"answer\":\"The guide states that CMS assigned different product-specific HCPCS codes to identify ESRD utilization compared with non-ESRD utilization. Providers must use the appropriate HCPCS code depending on the use case.\"},{\"question\":\"What key modifiers may be used when billing RETACRIT?\",\"answer\":\"The guide describes modifiers tied to unused/discarded drug amounts, anemia due to chemotherapy or radiotherapy, hematocrit/hemoglobin thresholds, and route of administration for ESRD claims. It also notes additional modifiers may be appropriate depending on payer requirements.\"}]","RETACRIT Billing and Coding Guide - Important Billing and Coding Information | PDF",6]