March 31, 1998 h-88 medicare a bulletin

MEDICARE PART A BULLETIN
BILLING REQUIREMENTS FOR CLAIMS WITH DATES OF SERVICE ON
OR AFTER APRIL1, 1998, FOR ORAL ANTI-NAUSEA DRUGS AS FULL
THERAPEUTIC REPLACEMENTS FOR INTRAVENOUS DOSAGE FORMS
AS PART OF A CANCER CHEMOTHERAPEUTIC REGIMEN
ATTENTION MEDICARE BUSINESS OFFICE MANAGER: Please distribute to all appropri-
ate health care personnel.
The purpose of this bulletin is to formerly publish the changes to the Health Care Financing Adminis-tration (HCFA) regulations regarding Oral Anti-Nausea Drugs. Section 4557 of the Balanced BudgetAct (BBA) of 1997 provides coverage for oral anti-emetic drugs as full therapeutic replacements forintravenous dosage forms as part of a chemotherapeutic regimen provided that the drug is adminis-tered or prescribed by a physician for use immediately before, at, or within 48 hours after the time ofadministration of the chemotherapeutic agent.
For purpose of this provision, the allowable period of covered therapy shall be defined to include dayone, the date of service of the chemotherapy drug (beginning with the time of treatment), plus aperiod not to exceed two additional calendar days, or a maximum period up to 48 hours. As a result,if it is to be covered by Medicare the date of service of the chemotherapy drug plus two calendardays.
Payment for these drugs is made under Part B. Medicare pays 80 percent of the reasonable cost ofthese drugs furnished by a provider. Deductible and coinsurance apply. The provider bills for thesedrugs on the HCFA-1450 claims form or its electronic equivalent.
NOTE:Since oral anti-emetic drugs must be administered or prescribed by a physician for use imme-diately before, at, or within 48 hours after the time of administration of a chemotherapy drug, provid-ers must report the oral anti-emetic drug and the chemotherapy drug on the same claim.
Medicare Part A Customer Service 904/355-8899 * P.O. Box 2711 * Jacksonville, FL 32231 REVUNUE CODES AND HCPCS REPORTING
Providers bill for the cost of the oral anti-emetic drug utilizing revenue code636 in form locator 42“Revenue Code.” Providers report one of the following HCFA Common Procedure Coding Systems(HCPCS) codes in form locator 44 “HCPCS/Rates” for each drug reported.
Q0163 DIPHENHYDRAMINE HYDORCHLORIDE, 50mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapytreatment not to exceed a 48-hour dosage regimen.
Q0164 PROCHLORPERAZINE MALEATE, 5 mg, oral, FDA approved prescription anti-emetic, foruse as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment,not to exceed a 48-hour dosage regimen.
Q0165 PROCHLORPERAZINE MALEATE, 10 mg, oral, FDA approved prescription anti-emetic,for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treat-ment, not to exceed a 48-hour dosage regimen.
Q0166 GRANISETRON HYDROCHLORIDE, 1mg, oral, FDA approved prescription anti-emetic,for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treat-ment, not to exceed a 24-hour dosage regimen.
Q0167 DRONABINOL, 2.5mg, oral, FDA approved prescription anti-emetic, for use as a completetherapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a48-hour dosage regimen.
Q0168 DRONABINOL, 5mg, oral, FDA approved prescription anti-emetic, for use as a completetherapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a48-hour dosage regimen.
Q0169 PROMETHAZINE HYDROCHLORIDE, 12.5mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapytreatment, not to exceed a 48-hour dosage regimen.
Q0170 PROMETHAZINE HYDROCHLORIDE, 25mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapytreatment, not to exceed a 48-hour dosage regimen.
Q0171 CHLORPROMAZINE HYDROCHLORIDE, 10mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapytreatment, not to exceed a 48-hour dosage regimen.
Q0172 CHLORPROMAZINE HYDROCHLORIDE, 25mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapytreatment, not to exceed a 48-hour dosage regimen.
Q0173 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250mg, oral, FDA approved prescriptionanti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemo-therapy treatment, not to exceed a 48-hour dosage regimen.
Q0174 THIETHYLPERAZINE MALEATE, 10mg, oral, FDA approved prescription anti-emetic, foruse as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment,not to exceed a 48-hour dosage regimen.
Q0175 PERPHENAZINE, 4mg, oral, FDA approved prescription anti-emetic, for use as a completetherapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a48-hour dosage regimen.
Q0176 PERPHENAZINE, 8mg, oral, FDA approved prescription anti-emetic, for use as a completetherapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a48-hour dosage regimen.
Q0177 HYDROXYZINE PAMOATE, 25mg, oral, FDA approved prescription anti-emetic, for use asa complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not toexceed a 48-hour dosage regimen.
Q0178 HYDROXYZINE PAMOATE, 50mg, oral, FDA approved prescription anti-emetic, for use asa complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not toexceed a 48-hour dosage regimen.
Q0179 ONDANSETRON HYDROCHLORIDE, 8mg, oral, FDA approved prescription anti-emetic,for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treat-ment, not to exceed a 48-hour dosage regimen.
Q0180 DOLASETRON HYDROCHLORIDE, 100mg, oral, FDA approved prescription anti-emetic,for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treat-ment, not to exceed a 48-hour dosage regimen.
Q0181 UNSPECIFIED ORAL DOSAGE FORM, FDA approved prescription anti-emetic, for use asa complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not toexceed a 48-hour dosage regimen.
The 24-hour maximum drug supply limitation on dispensing, for HCPCS codes Q0166and Q0180, has been established to bring the Medicare benefit as it applies to thesetwo therapeutic entities in conformity with the “Indications and Usage” section ofcurrently Food and Drug Administration approved product labeling for each affecteddrug product.
In addition, when billing for chemotherapy drugs (which includes oral cancer and IV chemotherapydrugs), providers must report the HCPCS code of the chemotherapy drug in form locator 44 underrevenue code 636 in form locator 42.
When billing for an oral anti-emetic drug used in conjunction with a chemotherapydrug and the provider is utilizing the hard copy HCFA-1450 (UB-92) claims format,the provider must report the name of the oral anti-emetic drug and the chemotherapydrug in form locator 43 “Description” on the appropriate revenue lines.
LINE ITEM DATES OF SERVICE REPORTING
When billing for an anti-emetic drug used as full replacement for intravenous forms, providers arerequired to report line item dates of service for the oral anti-emetic drug and for the chemotherapydrug in order to implement the 48-hour requirement stated in the BBA. Line item dates of service inform locator 45 “Service Date” (MMDDYY). (See the example below.) SERVICE UNIT REPORTING
Providers are required to report the number of units of the oral anti-emetic drug and the chemo-therapy drug in the form locator 46 “Service Units” for each drug reported. Each HCPCS codedescriptor is equal to one service unit.
Providers complete the remaining items in accordance with regular billing instructions.
The following provides an example of how to bill for an oral anti-emetic drug used asfull replacement for intravenous forms administered in conjunction with a chemotherapy drug based on the reporting requirements above.
FOR THE HCFA 1450 (UB-92) FLAT FILE, REPORT AS FOLLOWS:
For the hard copy UB-92 (HCFA 1450), report as follows: EDITS THAT WILL BE APPLIED BY FICIAL INTERMEDIARY
The presence of a chemotherapy drug HCPC code for each oral anti-emetic drug HCPCS code(Q0163 to Q0181) reported and the HCPCS codes are reported on the same claim. If an oral anti-emetic drug HCPCS code is submitted but there is no chemotherapy HCPCS code reported, deny theclaim; and The date of service of the oral anti-emetic drug does not exceed the date of service of the chemo-therapy drug plus two additional calendar days. If the date of service of the oral anti-emetic drug isgreater than the date of the chemotherapy drug plus two additional calendar days, verify both dates.
If the verified date of service of the oral anti-emetic drug is greater than the date of service of thechemotherapy drug plus two additional calendar days, dent the claim for the oral anti-emetic.
Questions regarding this bulletin may be addressed to the Medicare Part A Customer Service Depart-ment by calling (904)355-8899.

Source: http://medicare.fcso.com/Publications_A/1998/138414.pdf