Capecitabine Oral Anti-Cancer Drug Billing Instructions Effective October 1, 2024

The following instructions apply to Capecitabine Oral Anticancer Drug (J8520 and J8521) billed under the  Oral Anticancer Drugs Local Coverage Determination (LCD L33826)External Link:

  • Dates of service on or after October 1, 2024:
    • Bill these drugs with HCPCS J8999 (Prescription drug, oral, chemotherapeutic, NOS) until J8522 (Capecitabine (Xeloda) is implemented in the DME MAC system.
    • When submitting these claims electronically in the X12 837P format, submit HCPCS J8999 in the 2400 SV101-2 element.
    • Submit the Drug name (Capecitabine or Xeloda), Dosage, and National Drug Code (NDC) in the claim 2300 NTE narrative segment.
    • Do not submit the National Drug Code (NDC) in the 2410 LIN03 element, or your claim will be rejected by CEDI.
  • Do not bill the new HCPCS code J8522 Capecitabine (Xeloda) until system changes are implemented to allow submission of the National Drug Codes (NDC).

There will be further instructions when you can bill the NDC codes for these drugs in the X12 837 2410 LIN03.

Post Date: 11/06/2024