Oral Anticancer Drugs and Oral Antiemetic Drugs
Oral anticancer drugs are covered under the oral anticancer drug benefit [Social Security Act §1861(s)(2)(Q)]. Oral Antiemetic Drugs are covered under the Oral Antiemetic Drug benefit (Social Security Act §1861(s)(2)(T)).
- Aprepitant for Chemotherapy-Induced EMESIS (110.18) National Coverage Determination (NCD)
- Oral Anticancer Drugs Local Coverage Determination (LCD) and Policy Article [PDF]
- Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) LCD and Policy Article [PDF]
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to help obtain documentation
- Oral Anticancer Drugs Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
|New ICD 10-Codes||NCD110.18 Aprepitant for Chemo-Induced Emesis has been updated. Added ICD-10 codes D04.111, D04.112, D04.121, and D04.122. See CMS Medicare Learning Network (MLN) Matters (MM)10859 for details.|
- CMS Internet Only Manual (IOM), Publication 100-02, Chapter 15 - Self-Administered Drugs and Biologicals
- CMS IOM, Publication 100-04, Chapter 17 - Oral Cancer Drugs and Oral Anti-Emetic Drugs
- CMS Medicare Learning Network (MLN) Matters (MM)9386 - Authoritative Sources Used in Determination of "Medically-Accepted Indication" of Drugs and Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimen
- National Drug Codes for Oral Anti-Cancer Drugs (OACD)
- NCPDP - NCPDP Companion Document
Last Updated Jan 10, 2020
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.