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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)External Website:

  • 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 PDACExternal Website.

Publication History

February 19, 2025 Revised billing instructions for dates of service on or after January 1, 2025.
August 22, 2024 Originally Published

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