Chemotherapy

Chemotherapy Drugs 

The chemotherapy drug used must be indicated by the specific HCPCS code. If there is not a specific HCPCS code for the chemotherapy drug, use an unlisted J code and include a valid National Drug Code (NDC) number. 

Chemotherapy Administration Procedure Codes 96400-96549

Chemotherapy administration procedure codes will be considered for payment when the service was performed by a physician. If the service was performed by a nurse, the service is considered global and will be denied.       

Monitoring services by the physician are not covered.       

When chemotherapy administration is performed in a place of service other than the office, the claim will pend for review for content of service determination. If the service is performed by a nurse in a setting other than the office, the service is considered global and will be denied.       

When a heparin flush and chemotherapy are administered on the same day, the heparin flush will be considered content of service and no additional reimbursement is allowed.       

Separate reimbursement is not provided for supplies used in the office setting for chemotherapy services. Supplies necessary for the delivery of chemotherapy are already considered within the reimbursement level for the services performed.