Does J8498 require prior authorization?

No, J8498 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J8498?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Backwork Sign up free

`J8498`, Antiemetic drug, rectal/suppository, not otherwise specified

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier prior to claim submission for items requiring an SWO.
For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD listing the base item (and may list associated options/accessories) prior to delivery.

For refills, suppliers must contact the beneficiary and document an affirmative response prior to dispensing the refill and document the refill request; contact must occur no sooner than 30 days prior to expected end of current supply.

Claims and documentation must also meet the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, and Supplier Manual requirements as applicable.

Key Coverage Criteria

Oral anticancer drugs are covered when they are eligible for a defined Medicare benefit category, are reasonable and necessary for diagnosis or treatment (or to improve functioning of a malformed body member), and meet all applicable Medicare statutory and regulatory requirements.
Coverage requires that the statutory coverage criteria for oral anticancer drugs, as specified in the related LCD Policy Article, are met and the drug must be reasonable and necessary for the individual beneficiary.
Oral anticancer and oral antiemetic drugs are covered only if dispensed and billed to Medicare by the entity that actually dispenses the drug to the beneficiary and that entity is permitted under applicable federal, state, and local laws to dispense drugs.

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J8498 Sign up free

`J8498`, Antiemetic drug, rectal/suppository, not otherwise specified

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

J8498, Antiemetic drug, rectal/suppository, not otherwise specified

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`J8498`, Antiemetic drug, rectal/suppository, not otherwise specified