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;

 

 

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