Billing and Coding: Chemotherapy

Medicare Part B covers chemotherapeutic agents when the use is FDA-approved, listed in NCCN Guidelines at category 2B or higher, or included in approved compendia per assigned ratings. Off-label uses may be permitted if identified with the KX modifier and supported by full peer‑reviewed publications (excluding in‑house publications and abstracts) and are subject to Palmetto GBA review; wastage from single‑dose vials must be reported with the JW modifier. Billing must include required information in Box 19 (CMS‑1500) or FL80 (UB‑04) and follow specified coding for J‑coded and non‑J‑coded drugs.

"Medicare covers chemotherapeutic agents for indications listed as approved in the FDA label."

Sign up to see full coverage criteria, indications, and limitations.