Editing for Coverage Article, Billing and Coding: Chemotherapy A56141 to be Turned On

Local Coverage Article A56141 went into effect November 1, 2018. Since then, Palmetto GBA has given providers this period of time to comply with the coverage requirements listed in the article. Over the next several months, Palmetto GBA will be implementing the procedure to diagnosis editing for HCPCS codes outlined in the coverage article. As this editing is implemented, Palmetto GBA will update our communications to provide effective dates for any editing that is installed. All other coverage requirements outlined in the coverage article remain in effect. Providers should pay specific attention to the coverage article as it relates to billing off label use and the HCPCS modifier KX for any drug or biological outlined in the article. Palmetto GBA will provide a recorded webcast within the next few weeks with brief highlights of the coverage article and remind provider how to locate the coverage article.


Last Updated: 04/22/2020