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Oral Antiemetic Drugs: Coverage Reminder—November 2010 (A50451)

Recently, the DME MAC have received questions regarding the coverage requirements in the LCD for Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) (L27005) and related policy article (PA). Coverage of oral antiemetic drugs is a specific Medicare benefit category found in the Social Security Act, Title XVIII, Section 1861(s)(2)(T) with further instructions for coverage in the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 80.2. (293 KB)

Questions recently raised relate to the requirement that the oral antiemetic must be initiated within two hours of the administration of the chemotherapeutic agent. This means that the first dose of the oral antiemetic drug or drugs (if part of a multi-drug regimen), must be administered to the beneficiary within two hours of initiation of the cancer chemotherapeutic regimen. This does not mean that the pharmacy must dispense the drug or fill a prescription within two hours of administration of the drug(s). In addition, the amount dispensed must not exceed the maximum dosing time period limitation of 24 or 48 hours as described in the HCPCS code descriptor for each drug.

Suppliers should refer to the LCD and related PA for oral antiemetic drugs (replacement for intravenous drugs) for additional coverage, coding, and documentation requirements.

Oral Antiemetic Drugs: Coverage Reminder—November 2010 (A50451)
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