Library: Policy

317:30-5-15. Chemotherapy injections

Revised 1-18-08

(a) Outpatient.

• (1) Outpatient chemotherapy is compensable only when a malignancy is indicated or for the diagnosis of Acquired Immune Deficiency Syndrome (AIDS).  Outpatient chemotherapy treatments are unlimited.  Outpatient visits in connection with chemotherapy are limited to four per month.

• (2) Payment for administration of chemotherapy medication is made under the appropriate National Drug Code (NDC) and HCPCS code as stated in OAC 317:30-5-14(b).  Payment is made separately for office visit and administration under the appropriate CPT code.

• (3) When injections exceed listed amount of medication, show units times appropriate quantity, i.e., injection code for 100 mgm but administering 300, used 100 mgm times 3 units.

• (4) Glucose - fed through IV in connection with chemotherapy administered in the office is covered under the appropriate NDC and HCPCS code.

(b) Inpatient.

• (1) Inpatient hospital supervision of chemotherapy administration is non-compensable.  The hospital visit in connection with chemotherapy could be allowed within our guidelines if otherwise compensable, but must be identified by description.

• (2) Hypothermia - Local hypothermia is compensable when used in connection with radiation therapy for the treatment of primary or metastatic cutaneous or subcutaneous superficial malignancies.  It is not compensable when used alone or in connection with chemotherapy.

• (3) The following are not compensable:

  • (A) Chemotherapy for Multiple Sclerosis;

  • (B) Efudex;

  • (C) Oral Chemotherapy;

  • (D) Photochemotherapy;

  • (E) Scalp Hypothermia during Chemotherapy; and

  • (F) Strep Staph Chemotherapy.