PHARMACY SUPPLY CODES
Updated as of January 8, 2008
For 2008, CMS established a monthly pharmacy supplying fee for oral anti-cancer chemotherapeutic drugs. Each pharmacy licensed provider is eligible for one $24 fee per beneficiary per 30-day supply of XELODA per month. CMS will pay an additional, but reduced, fee if a different strength of XELODA is dispensed in the same month. In order to receive the supplying fee, the following codes must be used.
| HCPCS Code | Description | 2008 Payment Rates |
|---|---|---|
| Q0511 | Pharmacy supply fee for first 30-day prescription | $24.00 |
| Q0512 | Pharmacy supply fee for subsequent 30-day prescription | $16.00 |
Claims for covered oral anti-cancer drugs and pharmacy supplying fee must be submitted on the CMS-1500 claim form or its electronic equivalent to the appropriate Durable Medical Equipment Medicare Administrative Contractor (DMEMAC).
As the name implies, each DMEMAC handles claims administration for a specific geographic region for all Medicare-covered durable medical equipment as well as claims for covered oral chemotherapy and oral anti-emetic drugs.
