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Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics Policy) Clarification

The oral antiemetic drugs are covered under this policy for patients with a covered cancer diagnosis and used as a full therapeutic replacement for an intravenous antiemetic drug that would other wise have been administered at the time of the chemotherapy treatment. The initial dose of the oral antiemetic drugs is administered within two hours of the administration of the chemotherapeutic agent and subsequent doses are administered during a period not to exceed 48 hours from that time. The oral antiemetic drugs under this policy are not covered if used with an oral anticancer drug (please refer to the oral anticancer drugs LCD). For oral antiemetic drugs that do not have a corresponding code, Q0181 is to be billed with the following information as stated in the LCD:

“Claims for code Q0181 must be accompanied by the name of the drug, the manufacturer, the dosage strength dispensed, the number of tablets and frequency of administration during the covered time period (24–48 hours) as specified on the order. This information should be entered in the narrative field of an electronic claim.” 

The quantity or oral antiemetic drugs that are dispensed should be limited to a 30-day supply. Order may be refillable. 

Aprepitant (J8501) and Dexamethasone (J8540) 

Aprepitant (J8501) and dexamethasone (J8540) are covered if, in addition to meeting the statutory coverage criteria specified in the related policy article, they are administered to patients who are receiving one or more of the anticancer chemotherapeutic agents in the local coverage determination policy. Modifier KX should be added to each code if billed with one of the covered anticancer chemotherapeutic agents. 

Aprepitant (J8501) and dexamethasone (J8540) are covered only if, in addition to the general criteria listed above, they are administered as part of an oral antiemetic three-drug regimen which includes a 5-HT3 antagoinst (i.e., granisetron [Q0166], ondansetron [Q0179], or dolasetron [Q0180]). If aprepitant and/or dexamethasone are not used as part of this three-drug regimen, they will be denied as noncovered. The oral antiemetic three-drug regimen should be submitted on the same claim. 

Refer to the oral antiemetic drugs (replacement for intravenous antiemetics drugs LCD on our Web site.

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Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics Policy) Clarification
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