RETIRED - Billing Reminder - Units of Service for Oral Anticancer Drugs (OACD)


Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Posted March 22, 2013

Oral Anticancer drugs have unique billing requirements. Recently errors in billing for these drugs have been identified. Suppliers are reminded:

  • Only the drugs listed in the policy are covered. The oral anticancer drugs that are addressed in this policy are:
    • Busulfan
    • Capecitabine
    • Cyclophosphamide
    • Etoposide
    • Fludarabine phosphate
    • Melphalan
    • Methotrexate
    • Temozolomide
    • Topotecan
  • National Drugs Codes (NDCs) may be billed only when the drug is used as an oral anticancer drug.
  • For all NDC numbers, 1 unit of service = 1 tablet or 1 capsule.
  • Suppliers must use the NDC that matches the product dispensed.
  • HCPCS J codes for these drugs must not be used when billing for these drugs
  • Under the Metric Decimal Quantity and the Billing Unit Standard for NCPDP, solid oral dosage forms (tablets, capsules, etc.) are billed as "each" i.e., 1 unit of service = 1 tablet or 1 capsule each
  • Under no circumstances should the number of grams, milligrams, etc. be used for the UOS

Refer to the LCD, related Policy Article and Supplier Manual for additional information about coverage, documentation and billing for these items.


Last Updated Dec 11 , 2023