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Fact Sheet

Oral Anticancer & Oral Antiemetic Drugs: Supply Fees Fact Sheet

This fact sheet provides guidance for billing supply fees for oral anticancer and oral antiemetic drugs and tips to avoid common denials.

Supply Fee HCPCS Codes

HCPCS Descriptor
Q0511 Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period
Q0512 Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period

Billing Rules

  • Bill supply fees only when the drug is covered under the Oral Anticancer Drugs or Oral Antiemetic Drugs LCDs.
    • If Medicare denies the drug on the claim as non-covered, Medicare will also deny the supply fee as non-covered.
  • Bill the supply fee on the same claim as the drug(s). If you submit the supply fee separately, Medicare will deny the supply fee for incorrect billing.

Units of Service

  • Q0511:
    • Bill 1 unit of service for the first covered oral anticancer drug that you dispense in a 30-day period.
    • If a single pharmacy bills more than 1 unit of service of Q0511 per 30 days, Medicare will deny the excess units as incorrect coding.
    • If more than one pharmacy dispenses covered drugs during a 30-day period, Medicare covers 1 unit of Q0511 for each pharmacy.
  • Q0512:
    • Bill 1 unit of service for each subsequent covered oral anticancer drug you dispense in a 30-day period.

Other Rules

  • If you dispense 2 dosage strengths of the same drug on the same day, Medicare will cover 1 unit of service of the appropriate supply fee for each strength.
  • If the units of service of Q0511 or Q0512 exceed the number of drugs on the claim, Medicare will deny the excess units as not separately payable.

Tips to Avoid Common Errors

  • Incorrect HCPCS Billed
    • HCPCS codes must match the service you provide.
      • Q0511 is for the first prescription in a 30-day period (per pharmacy)
      • Q0512 is for subsequent prescription in that 30-day period
  • Multiple Supply Fees
    • If you bill more than 1 supply fee for the same drug within 30 days, Medicare will deny the extra supply fee(s).
    • If you dispense 2 different strengths of the same drug on the same day, bill a supply fee for each strength.
  • Related Drug Not Included
    • Bill the supply fee on the same claim as the drug code.
  • Noncovered
    • If Medicare denies a drug as non-covered, Medicare will also deny the supply fee as non-covered.
  • Prevent Duplicate Denials
    • Use the myCGS® Web PortalExternal Website to check claim history to see which supply fees were already billed during the month.

Resources

Published: 02.19.2026

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