February 19, 2025
Capecitabine Oral Anti-Cancer Drug Billing Instructions
These instructions apply to Capecitabine Oral Anticancer Drugs billed under the Oral Anticancer Drugs Local Coverage Determination (LCD L33826):
- Dates of service October 1 – December 31, 2024 (J8520 and J8521):
- Bill these drugs with HCPCS code J8999 (Prescription drug, oral, chemotherapeutic, NOS) until J8522 [Capecitabine (Xeloda)] is implemented in the system.
- Do not bill these drugs using the National Drug Code (NDC)
- Claim narrative field: Drug name (Capecitabine or Xeloda) Dosage, and National Drug Code (NDC).
- Dates of service on or after January 1, 2025:
- Bill these drugs with the NDC instead of a HCPCS code. This is consistent with billing 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, quantity of tablets in a package, and other packaging details. Suppliers must use the NDC that matches the product dispensed. Do not use HCPCS J codes for capecitabine prescribed for use as an oral anti-cancer drug for dates of service on or after January 1, 2025.
Narrative Field:
- Electronic Claims: NTE 2300 or NTE 2400 narrative segment field
- Paper Claims (CMS-1500 Claim Form): Item 19
For questions about correct coding, contact the PDAC.
Publication History
February 19, 2025 | Revised billing instructions for dates of service on or after January 1, 2025. |
August 22, 2024 | Originally Published |