• Drugs are billed in multiples of the dosage specified in the HCPCS/NDC. If the dosage given is not a multiple of the Health Insurance Common Procedure Coding System (HCPCS) code, the provider rounds to the next highest units in the HCPCS description for the code.
• If the full dosage provided is less than the dosage for the code specifying the minimum dosage for the drug, the provider reports the code for the minimum dosage amount

• When claims are submitted for HCPCS codes J9999 (not otherwise classified anti-neoplastic drugs), J3490 (unclassified drugs) and J3590 (unclassified biological drugs), the drug name, the National Drug Code (NDC) number and total dosage must be indicated in the narrative field of the CMS-1500 claim form. The correct number of units for submitting a not otherwise classified (NOC) code is always '1' one. The reimbursement will be based on the dosage indicated in the narrative field.

• Discarded portions - CMS encourages physicians to schedule patients in such a way that they can use drugs most efficiently. However, if a physician must discard the remainder of a vial or other package after administering it to a Medicare patient, the program covers the amount of drug discarded along with the amount administered. When submitting a claim for situations when a portion of the drug is supplied is unused (discarded) include the total of both the unused and the used portion in the days/units field when reporting the dosage.
• The coverage of discarded drugs applies only to single use vials. Multi-use vials are not subject to payment for discarded amounts of drugs.

• Intravenous fluid administration when administration of a chemotherapeutic agent does not require it to be administered by infusion in a volume of 250 cc or greater (i.e., HCPCS codes J7030-J7050, J7060, J7070, J7120) will be denied
• Intravenous fluids used to maintain venous patency during administration of chemotherapeutic agents are considered integral to chemotherapy and is not separately billable
• Flushing of a vascular access device will be denied if submitted on a claim on the same date of service as the administration of chemotherapy

• Use HCPCS code J9999. Use HCPCS code J9999 even though the drug may have an assigned HCPCS code.
• Indicate OFF-LABEL CHEMO DRUG - SPECIAL CONSIDERATION in the narrative field of the CMS-1500 claim form
• The name of the drug, the NDC number and dosage must also be in the narrative field of the CMS-1500 claim form
• Submit required documentation as listed in CMS Benefit Policy Manual, Chapter 15, and Section 50.4.5 should be submitted with the initial claim

• Use HCPCS code J9999
• Indicate OFF-LABEL CHEMO DRUG - SPECIAL CONSIDERATION in the narrative field of the CMS-1500 claim form
• The name of the drug, the NDC number and dosage must also be in the narrative field of the CMS-1500 claim form
• Subsequent claims for the same patient will not need the additional documentation for off-label use to be submitted once the initial claim has been paid

No documents found