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April 16, 2020

CGS is Retiring Policy L34093 Chemotherapy and Biologicals

CGS Administrators will be retiring policy L34093 Chemotherapy and Biologicals effective June 7, 2020. This policy is being replaced with article A58113 Off -Label Use of Anti-Cancer Drugs and Biologicals that becomes effective on June 8, 2020.

We wanted to let the provider community know of this change prior to being implemented as this is a change from how we currently handle chemotherapy and biological drugs. While there will no longer be a local policy in place with attached billing and coding articles, we will be using the coverage indications as listed in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) 100-02, Chapter 15, section 50.4.1 and 50.4.5 which is the basis for the current policy. CGS will cover these types of drugs based on FDA label indications and for off label use if listed in one of the five CMS approved compendia’s (NCCN, Micromedex Drug DEX, Lexi-Drugs, AHFS, or Clinical Pharmacology). 

CGS will also review and consider other off label use requests that are not listed as supported/recommended in one of the compendia’s if the use is supported by clinical research identified in CMS IOM 100-02, Chapter 15, section 50.4.5. When submitting a request for off label use not currently listed in a compendium please submit full articles.

CGS will be hosting a webinar on these changes on May 7, 2020 and encourage providers to attend. Please watch for additional information on our Calendar of Events web page.

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