COVERAGE POLICY

Medicare Part B Local Coverage Determinations (LCD): Coverage for Approved Oral Anti-Cancer Drugs

• Jurisdiction A | National Heritage Insurance Company (LCD)
• Jurisdiction B | NGS formerly Administar (LCD)
• Jurisdiction C | CIGNA Government Services (LCD)
• Jurisdiction D | Noridian Administrative Services (LCD)
• Medicare DMEMAC Contact Information by Jurisdiction

CMS and Medicare Information

• Centers for Medicare and Medicaid Services (CMS) Homepage
• Medicare Claims Processing Manual
• Chapter 17 - Drugs and Biologicals
• Chapter 17 - Supplemental Chapters & Transmittals
• Medicare Benefit Policy Manual
• Chapter 15 - Covered Medical and other Health Services
• Chapter 15 - Supplemental Chapters & Transmittals
• CMS Regulation and Guidance Page

PATIENT ASSISTANCE

• Reimbursement Hotline
• Patient Assistance Program

HELPFUL RESOURCES

General

• Xeloda FDA Approval Letter - Dukes' C Colon Cancer
• Xeloda FDA Approval Letter - Metastatic Breast Cancer
• Xeloda FDA Approval Letter - with Taxotere for Metastatic Breast Cancer
• Xeloda FDA Approval Letter - Metastatic Colorectal Carcinoma
• XELODA Package Insert

Wholesaler and Pharmacy Information

• Health Care Programs & Services includes Wholesaler Fact Sheets, Material Safety Data Sheets & Authorized Distributors of Roche
• Specialty Pharmacy Providers

Related Links

• Helpful Resource Links
• Roche Exchange - Oncology

UPDATES

BILLING & CODING

DMEMAC

• Hospital Billing for Take Home Drugs
• SADMERC Oral Anti-Cancer Drug List
• National Supplier Clearinghouse
• National Heritage Insurance Company DMEMAC Homepage
• NGS formerly Administar DMEMAC Homepage
• CIGNA Government Services DMEMAC Homepage
• Noridian Administrative Services DMEMAC Homepage

Electronic Billing Submissions for the DMEMAC and HOPPS Settings

• National Heritage Ins. Co. Electronic Billing Submission
• NGS formerly Administar Electronic Billing Submission
• CIGNA Government Services Electronic Billing Submission
• Noridian Administrative Services Electronic Billing Submission

General Billing, Coding and Payment Information

• National Drug Code (NDC) Fact Sheet
• Medicare Payment Allowable
• HCPCS CODES: Fact Sheet for Hospital Billing
• Common Billing FAQ
• Commonly Used Diagnosis Codes
• Medicare Coding and Billing Fast Facts for Xeloda

Hospital Outpatient Prospective Payment System (HOPPS)

• CMS UB04 Fact Sheet & Annotated Form
• Hospital Billing for Take Home Drugs

Pharmacy

• CMS Pharmacy 1500 Fact Sheet & Annotated Form
• Pharmacy Supply Codes

Physician’s Office

• CMS Physician 1500 Fact Sheet & Annotated Form

Retail Pharmacy Electronic Billing Guidelines | NCPDP Companion Guidelines

• National Heritage Ins. Co. Companion Guidelines
• NGS formerly Administar Companion Guidelines
• CIGNA Government Services Companion Guidelines
• Noridian Administrative Services Companion Guidelines

Sample Letters

• Sample Appeal Letter
• Sample Letter of Medical Necessity