Article Detail - JA DME

Oral anti-cancer drugs (OACD) must be billed to the Durable Medical Equipment Medicare Administrative Contactors (DME MACs) with the National Drug code (NDC) that matches the product/HCPCS code dispensed. The following instructions pertain to the billing of oral Capecitabine covered under the Oral Anticancer Drugs Local Coverage Determination (LCD L33826).

• Effective October 1, 2024 - December 31, 2024
  • Suppliers must bill Capecitabine with HCPCS code J8999 (prescription drug, oral, chemotherapeutic, NOS) for processing dates between October 1, 2024, and December 31, 2024. The following should have been included in those claims processed between that time frame:
    • Claim narrative: drug name (Capecitabine or Xeloda), dosage, and National Drug Code (NDC).
    • Electronic claims: NTE 2300 or NTE 2400 narrative segment field.
    • Paper claims (CMS-1500 Claim Form): Line Item 19.
    Note: Do not bill Capecitabine with the National Drug Code (NDC) for claims processed between October 1, 2024, and December 31, 2024.
  • HCPCS codes J8520 and J8521 for Capecitabine were end-dated as of September 30, 2024, as indicated by the PDAC.
    • New HCPCS code for Capecitabine, J8522, was effective October 1, 2024, but was not implemented until January 1, 2025, therefore no crosswalk was available for processing dates between October 1, 2024, and December 31, 2024.
• Effective January 1, 2025
  • HCPCS code J8522 for Capecitabine was implemented on January 1, 2025, and was effective for DOS on or after October 1, 2025, with a crosswalk to the appropriate NDC.
    • For claims submitted on or after January 1, 2025, for dates of service between October 1, 2024, and December 31, 2024, supplier must bill the NDC for J8522.
    Note: Do not bill Capecitabine using J8522 or J8999 for claims submitted on or after January 1, 2025. Suppliers must use the appropriate NCD that cross walked to J8522.