About this policy
The article will address anti-neoplastic agent codes provided for treatment of noncancer diagnoses or to substances such as monoclonal antibody agents, and other biologic response modifiers. The drugs cited are not intended to be a complete list of drugs that may be administered using the chemotherapy administration codes. Coverage for medication is based on the patient’s condition, the appropriateness of the dose and route of administration, based on the clinical condition, medical necessity and the standard of medical practice regarding the effectiveness of the drug for the diagnosis and condition. The listing of the chemotherapy agent and procedure code do not imply coverage. All the procedure codes are subject to Medicare rules and regulations, applicable Local Coverage Determinations (LCDs), and medical necessity. Chemotherapy agents may be subject to NCCI (National Corrective Coding Initiative) editing and hospital outpatient prospective payment system rules.
Documentation requirements
N
/
A
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| J9190 | HCPCS | Covered |
| J9215 | HCPCS | Covered |
| J9260 | HCPCS | Covered |
| J9312 | HCPCS | Covered |
| Q5115 | HCPCS | Covered |
| Q5119 | HCPCS | Covered |
| Q5123 | HCPCS | Covered |
| A63.0 | ICD10CM | Covered |
| B07.0 | ICD10CM | Covered |
| B07.8 | ICD10CM | Covered |
| B07.9 | ICD10CM | Covered |
| B27.00 | ICD10CM | Covered |