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August 22, 2024

Capecitabine Oral Anti-Cancer Drug Billing Instructions Effective October 1, 2024

The following instructions apply to Capecitabine Oral Anticancer Drug (J8520 and J8521) billed under the Oral Anticancer Drugs Local Coverage Determination (LCD L33826)External Website:

  • Dates of service on or after October 1, 2024:
    • Bill these drugs with HCPCS J8999 (Prescription drug, oral, chemotherapeutic, NOS) until J8522 (Capecitabine (Xeloda) is implemented in the system.
    • Claim narrative field: Drug name (Capecitabine or Xeloda) Dosage, and National Drug Code (NDC).
  • Do not bill the new HCPCS code J8522 Capecitabine (Xeloda) until system changes are implemented to allow submission of the National Drug Codes (NDC).
  • We'll let you know when you can bill the NDC codes for these drugs.

Claim Narrative Field:

  • Electronic Claims: NTE 2400
  • Paper Claims (CMS-1500 Claim Form): Item 19

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