Oncology & Hematology Coding Alert

Keep these common drug codes at your fingertips

Use the charts above to quickly look up how to code common drug combinations used to treat Hodgkin's. Plus: See how special coverage instructions affect these codes.

KEY:

 * For outpatient drugs, Medicare covers drugs furnished "incident-to" a physician's service if the drugs aren't usually self-administered. (Medicare Benefit Policy, Chapter 15, Section 50, "Drugs and Biologicals")

 ** Non-covered by Medicare.

 # Medicare Part B does not cover self-administered drugs, unless provided by statute. Medicare will cover certain oral anti-cancer drugs. (Medicare Benefit Policy, Chapter 15, Section 50.5, "Self -Administered Drugs
and Biologicals")

To be covered, an oral anti-cancer drug must be prescribed as chemotherapeutic, be approved by the FDA for the prescribed use, have the same active ingredients and chemical name and be used for the same indications as the non-self-administrable drug, and be reasonable and necessary for the patient. You must have a diagnosis of cancer for Medicare to pay. (Medicare Transmittal 1790)
 
Payers evaluate unlabeled uses of FDA-approved drugs for anti-cancer regimens (such as Prednisone) to see if you're using it for a medically accepted indication. The regimen must be a drug combination clinically recognized for treating a specific type of cancer. This includes drugs used to treat side-effects of the chemotherapy. (Medicare Carriers Manual, Part 3, Chapter II, Section 2049.4.C)