Are there circumstances where Medicare directs providers to bill DMEMACs for XELODA with HCPCS codes, as opposed to NDCs?
Under most circumstances, the Oral Anti-Cancer Drug LCDs and related policy articles direct Medicare suppliers to use NDCs when billing for XELODA. However, per CMS Transmittal 588 and MLN Matters Number MM3742, Medicare has directed DMEMACs to accept certain XELODA Clinical Trial Claims (subject to Section 110.17 – Anti-cancer Chemotherapy for Colorectal Cancer of the National Coverage Determinations Manual) with HCPCS codes J8520 (capecitabine, oral, 150 mg) and J8521 (capecitabine, oral, 500 mg) when accompanied by the “QR” modifier to show use in a clinical trial.
