Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)

Paclitaxel (including albumin-bound formulations) is covered when administered intravenously for cancer indications consistent with FDA labeling or, for off-label uses, when supported by recognized compendia and documented dosing. Albumin-bound paclitaxel requires documentation of prior anthracycline therapy unless contraindicated; proper use of JW/JZ modifiers and documentation of amounts administered/wasted or absence of waste (effective 7/1/2023) is required, and dosing/frequency beyond established parameters may be subject to medical necessity review.

"Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling."

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