Oral Anti-Cancer Drugs – Coding and Billing Change

Recently suppliers have raised questions about the proper billing of oral anti-cancer drugs (OACDs).  Questions related to the use of the Pricing, Data Analysis and Coding (PDAC) contractor listing of OACDs and NDC codes.  Effective May 1, 2013, instructions for determining the proper NDC code are changed. 

According to the current OACD Local Coverage Determination Related Policy Article Coding Guidelines section:

A list of valid NDC numbers for covered oral anticancer drugs can be found on the Pricing, Data Analysis and Coding (PDAC) Contractor web site. Until a new NDC number is added to the list, suppliers must submit claims using code J8999.

Previous education instructed suppliers to use the PDAC “Oral Anticancer Drug (OACD)” list to determine the covered drugs and proper NDC code for billing.  This list is updated on a quarterly basis. In some cases, new NDC codes are added to the market but may not yet appear on the PDAC OACD list resulting in the requirement to use miscellaneous code J8999.

Effective May 1, 2013, the Coding Guidelines will instruct suppliers to reference the PDAC “NDC/HCPCS Crosswalk” and no longer reference the PDAC OACD list.   NDC numbers for covered oral anticancer drugs are included on the NDC/HCPCS list. This list is updated monthly and should be referred to for appropriate coding of OACDs. Until a new NDC number is added to the list in the monthly update, suppliers have two options:

1. Hold claim submission until the NDC/HCPCS Crosswalk reflects the monthly update of covered OACDs; or,
2. Submit claims using code J8999.

The NDC/HCPCS Crosswalk files can be found on the PDAC web site.

Suppliers should refer to the OACD LCD and Related Policy Article and Supplier Manual for additional coverage, coding and documentation requirements.