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)).

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ICD 10-Codes Update NCD 110.18 Aprepitant for Chemo-Induced Emesis has been updated to add ICD-10 diagnosis codes C56.3, C79.63, C84.7A as coverable effective October 1, 2021. ICD-10 diagnosis codes D49.89, D49.4, D49.511, D49.512, D49.6 were removed effective April 1, 2022. See CMS Medicare Learning Network (MLN) Matters (MM) 12480  for details.
Note: A drug that isn’t available in an injectable form does not meet criterion 2. If an oral anticancer drug is used for immunosuppression (rather than the treatment of cancer), criterion 3 is not met and Medicare does not cover the drug under the oral anticancer drug benefit. If the drug is used for immunosuppression following an organ transplant, refer to the Immunosuppressive Drugs policy.

 

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Last Updated Fri, 29 Apr 2022 15:28:39 +0000

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