Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

Chemotherapy administration and agent codes may be used to bill for drugs given for non-oncologic indications when the drug, dose, and route are appropriate and medically necessary and consistent with standard practice. Coverage is not automatic based on listing; payment is determined by Medicare rules, applicable LCDs, NCCI edits, HOPPS rules, and required medical record documentation, including any LCD prior authorization requirements.

"Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary..."

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