UnitedHealthcare Medicare Advantage Notification for Outpatient Injectable Chemotherapy

March 2018 ~

UnitedHealthcare (UHC) Medicare Advantage (MA) plans in Florida and Georgia and soon Wisconsin, will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.

Effective March 1 for Florida and Georgia and April 1 for plans in Wisconsin, UHC MA will require notification members in the following plans:

• AARP^® MedicareComplete^®
• Care Improvement Plus^®
• UnitedHealthcare Dual Complete^®
• UnitedHealthcare^® Group Medicare Advantage retiree plans

Notification will be required for:

• Chemotherapy injectable drugs (J9000 – J9999), Leucovorin (J0640) and Levoleucovorin (J0641)
• Chemotherapy injectable drugs that have a Q code
• Chemotherapy injectable drugs that haven’t received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code
• All outpatient injectable chemotherapy drugs started after the notification effective date
• Adding a new injectable chemotherapy drug to a regimen

Notification will not be required for:

• Radio-therapeutic agents (e.g., Zevalin and Xofigo)
• Oral chemotherapy drugs, which are covered under a member’s pharmacy benefit plan
• Growth factors including: J2505 (neulasta), J1442, (neupogen), J2820 Leukine® (sargramostim), Q5101, (Filgrastim–biosimilar Zarxio), J1447 Granix(tbofilgrastim)
• Use of chemotherapy drugs for non-cancer diagnosis

Source(s): UnitedHealthcare Network Bulletin;