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 11, 2019
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