June 19, 2024
Methotrexate Oral Anti-Cancer Drug Billing Instructions Effective July 1, 2024
The following instructions apply to Methotrexate (Jylamvo and Xatmep) billed under the Oral Anticancer Drugs Local Coverage Determination (LCD L33826):
- Dates of service July 1, 2024, through September 30, 2024:
- Bill these drugs with HCPCS J8999 (Prescription drug, oral, chemotherapeutic, NOS).
- Claim narrative field: Drug name (Jylamvo or Xatmep), Dosage, and National Drug Code (NDC).
- Do not bill using the two new Methotrexate HCPCS codes which are effective July 1, 2024 (J8611 Methotrexate (Jylamvo), oral, 2.5 mg and J8612 - Methotrexate (Xatmep), oral, 2.5 mg)
- Dates of service on or after October 1, 2024:
- Bill these drugs with the NDC instead of a HCPCS code. This is consistent with the billing of other drugs under the Oral Anti-Cancer LCD.
The NDC is a number which uniquely identifies a manufacturer's product in terms of the strength of each tablet/capsule, quantity of tablets/capsules in a package, and other packaging details. Suppliers must use the NDC that matches the product dispensed. Do not use HCPCS J codes for methotrexate prescribed for use as an oral anti-cancer drug for dates of service on or after October 1, 2024.
Claim Narrative Field:
- Electronic Claims: NTE 2400
- Paper Claims (CMS-1500 Claim Form): Item 19