Current Provider-Administered Oncology Drug Policies

Kanjinti: See VP-0057 below.

Kymriah: For dates of service on or after January 1, 2019, through December 31, 2020, providers or facilities need to send requests and/or claims to Original Medicare. See Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers (CAG-00451N).

Nyvepria: See VP-0234 below.

Trazimera: See VP-0057 below.

Yescarta: For dates of service on or after January 1, 2019, through December 31, 2020, providers or facilities need to send requests and/or claims to Original Medicare. See Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers (CAG-00451N).

Ziextenzo: See VP-0234 below.

 

For billing and coding for Rituximab, refer to LCD L35026/Article A56380 for the following drugs:

Rituxan

Truxima

Ruxience

 

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

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 white cell colony stimulating factors, refer to LCD L37176/A56748 for the following drugs:

Fulphila Granix Leukine
Neulasta Neupogen Nivestym
Udenyca Zarxio  

Policy # Policy Title Print View
VP-0001 Abraxane® (paclitaxel protein-bound particles) (Intravenous)
VP-0007 Alimta® (pemetrexed) (Intravenous)
VP-0008 Aloxi® (palonosetron) (Intravenous)
VP-0014 Bevacizumab: Avastin®; Mvasi™; Zirabev™ (Intravenous)
VP-0036 Emend® (fosaprepitant dimeglumine) (Intravenous)
VP-0038 Erbitux® (cetuximab) (Intravenous)
VP-0043 Faslodex® (fulvestrant) (Intramuscular)
VP-0057 Trastuzumab: Herceptin®; Ogivri™; Kanjinti™; Trazimera™; Herzuma™; Ontruzant™ (Intravenous)
VP-0089 Nplate™ (romiplostim) (Subcutaneous)
VP-0136 Vectibix® (panitumumab) (Intravenous)
VP-0234 Colony Stimulating Factors – Pegfilgrastim: Neulasta®; Fulphila™; Udenyca™; Ziextenzo™; Nyvepria™ (Subcutaneous)
VP-0336 Cinvanti™ (aprepitant) (Intravenous)
VP-0363 Akynzeo® (fosnetupitant/palonosetron) (Intravenous)
VP-0482 Polivy™ (polatuzumab vedotin-piiq) (Intravenous)
VP-0503 Reblozyl® (luspatercept-aamt) (Subcutaneous)
VP-0521 Padcev™ (enfortumab vedotin-ejfv) (Intravenous)
VP-0522 Enhertu® (fam-trastuzumab deruxtecan-nxki) (Intravenous)
VP-0528 Sarclisa® (isatuximab-irfc) (Intravenous)
VP-0532 Trodelvy™ (sacituzumab govitecan-hziy) (Intravenous)
VP-0535 Darzalex Faspro™ (daratumumab and hyaluronidase-fihj) (Subcutaneous)
VP-0547 Evomela® (melphalan) (Intravenous)
VP-0550 Zepzelca™ (lurbinectedin) (Intravenous)
VP-0553 Phesgo™ (pertuzumab, trastuzumab and hyaluronidase-zzxf) (Subcutaneous)
VP-0558 Tecartus™ (brexucabtagene autoleucel) (Intravenous)
VP-0559 Monjuvi™ (tafasitamab-cxix) (Intravenous)
VP-0561 Blenrep® (belantamab mafodotin-blmf) (Intravenous)