Attend a Webinar

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

Documentation

Fees

Tips

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.

Resources

Articles

Last Updated Sep 19 , 2024

Related Articles

paginationType noridian
Articles Source Posted
Oral Anticancer Drugs Webinar - 10/22/2024 09/17/2024
Claims for Oral Anti-Cancer Drug Capecitabine 08/20/2024
Claims for Oral Anti-Cancer Drug Methotrexate (Revised) 07/03/2024
LCD and Policy Article Revisions Summary for December 14, 2023 12/14/2023
Policy Article Revisions Summary for September 21, 2023 09/21/2023