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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

Effective for dates of service October 1, 2024, the Oral Anticancer Drugs - Policy Article A52479 and Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article A52480 have been updated to reflect ICD-10 codes that support medical necessity. Refer to the policy 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 Sep 19 , 2024

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