Home - Medical Policies - Alabama
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- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
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Current Provider-Administered Oncology Drug Policies
Kanjinti: See VP-0057 below.
Nyvepria: For dates of service on or after January 1, 2021, see LCD L37176/article A56748. For dates of service prior to January 1, 2021, see VP-0234 below.
Provenge: See NCD 110.22 for Autologous Cellular Immunotherapy Treatment.
Riabni: For dates of service on or after October 1, 2021, see LCD L35026 and article A56380. For dates of service prior to October 1, 2021, see VP-0109 below.
Trazimera: See VP-0057 below.
Ziextenzo: See VP-0234 below.
For billing and coding for chemotherapy, refer to Palmetto article A56141 for the following drugs:
Adcetris |
Aliqopa |
Arzerra |
Bavencio |
Beleodaq |
Belrapzo |
Bendeka |
Besponsa |
Blincyto |
bortezomib, not otherwise specified |
Campath |
Cyramza |
Darzalex |
Doxil |
Imfinzi |
Empliciti |
Erwinaze |
Gazyva |
Halaven |
Herceptin |
Herceptin Hylecta |
Herzuma |
Imfinzi |
Istodax |
Ixempra |
Kadcyla |
Keytruda |
Kyprolis |
Lartruvo |
Lutathera |
Mylotarg | Ogivri | Onivyde |
Ontruzant |
Opdivo |
Perjeta |
Portrazza |
Poteligeo |
Tecentriq |
Torisel | Treanda | Velcade |
Vumon |
Vyxeos |
Yervoy |
Yondelis |
Zaltrap |
For chimeric antigen receptor (CAR) T-cell therapy for cancers, refer to NCD 110.24 for the following,
Abecma |
Breyanzi |
Kymriah |
Tecartus | Yescarta |
For erythropoiesis stimulating agents (ESAs) in cancer and related neoplastic conditions, refer to NCD 110.21 and LCD L39237/Article A58982.
darbepoetin alfa |
epoetin alfa |
epoetin alfa-epbx |
epoetin beta
|
For billing and coding for Rituximab, refer to LCD L35026/article A56380 for the following drugs:
Riabni |
Rituxan |
Ruxience | Truxima |
For white cell colony stimulating factors, refer to LCD L37176/article A56748 for the following drugs:
Fulphila | Granix | Leukine |
Neulasta | Neupogen | Nivestym |
Nyvepria | Udenyca | Zarxio |