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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)External Website:

  • 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


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