Wisconsin – Outpatient Injectable Chemotherapy Notification for UHC MA Plans

April 2018 ~

Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.

Notification will apply to members in the following UHC Medicare Advantage plan types:

• AARP^® MedicareComplete^®
• Care Improvement Plus^®
• UnitedHealthcare Dual Complete^®
• UnitedHealthcare^® Group Medicare Advantage retiree plans
• This is part of our effort to continually improve health care experiences and outcomes for our members. We have contracted with eviCore to provide a web-based application to review chemotherapy regimens

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., ZevalinTM and Xofigo^®)
• Oral chemotherapy drugs, which are covered under a member’s pharmacy benefit plan
• Growth factors including:
• J2505 (neulastaTM)
• 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 April 2018;