Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents

Medicare covers drugs and biologicals (including cancer chemotherapeutic agents) only if they meet the statutory definition—are FDA‑approved or included/approved in the statutorily named compendia—are not usually self‑administered, are incident to a physician’s services, are medically reasonable and necessary per accepted standards, are not excluded immunizations, and have not been found by the FDA to be less than effective; contractors may issue Local Coverage Determinations (LCDs) to define permitted uses. Non‑covered services must be billed with the appropriate modifier and may not be billed as covered.