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)).
Coverage
- 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]
Documentation
- Oral Anticancer Drugs Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Physician Letter - Medical Records [PDF] - Letter may be sent to physicians to help them obtain documentation
Fees
Resources
- 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 Mar 19, 2018
Related Articles
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.
RETIRED - Oral Anti-Cancer Drugs - Coding and Billing Change DMD May 25, 2017
RETIRED - Oral Anticancer Drugs - Covered Diagnoses DMD May 11, 2017
Oral Anti-Emetic Drugs - Coverage Reminder DMD May 11, 2017
New National Drug Codes (NDCs) for Etoposide DMD May 11, 2017
New National Drug Code (NDC) Numbers For Methotrexate DMD May 11, 2017