Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

Revision Effective Date: 01/01/2026
HCPCS CODES:
Removed: HCPCS codes J8650 and Q0174 from Group 1 Codes


01/08/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

Revision Effective Date: 01/01/2025
HCPCS CODES:
Added: HCPCS code Q0155


01/16/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

Revision Effective Date: 01/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: “and document an affirmative response” to language that pertains to contact with the beneficiary or caregiver/designee for DMEPOS products supplied as refills
Revised: “approaching exhaustion” to “expected to end” in regard to existing supplies
Revised: “Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date.” to “Contact with the beneficiary or designee regarding refills must take place no sooner than 30 calendar days prior to the expected end of the current supply.”
Revised: “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product.” to “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the expected end of the current supply.”


12/14/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to refill requirement information per CMS Final Rule CMS-1780-F.

Revision Effective Date: 01/01/2020
CODING INFORMATION:
Removed: Field titled “Bill Type”
 Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
As required by CR 10901, the ICD-10 information has been moved to all Policy Articles. There is no change in coverage.

Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
 Revised: “physician” to “treating practitioner”
 GENERAL:
 Revised: Order information as a result of Final Rule 1713
REFILL REQUIREMENTS:
Revised: “ordering physicians” to “treating practitioners”
GENERAL DOCUMENTATION REQUIREMENTS:
 Revised: “Prescriptions (orders)” to “SWO”


02/13/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

Revision Effective Date: 01/01/2019
 HCPCS CODES:
 Added: “ORAL” to HCPCS code J8655

Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and directions to Standard Documentation Requirements
Added: General Requirements
Revised: Refill Requirements
HCPCS Code:
Added: J8670
Deleted: Q9981
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous and Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Standard Documentation Language article
Retired bulletin article titled: Coverage and Coding - New Oral Antiemetic Drug Varubi®- Revised- Effective Date July 1, 2016

Revision Effective Date: 07/01/2016
HCPCS CODES:
Added: HCPCS code Q9981
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language to add New order requirements, and Correct coding instructions; revised Proof of delivery instructions (Effective 04/28/16)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Q9981 to billing instructions

Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.

Revision Effective Date: 01/01/2016
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Updated: 3-drug regimen billing instructions
HCPCS CODES:
Added: HCPCS code J8655
Deleted: HCPCS code Q9978
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: J8655 to modifier billing instructions
Added: End date for HCPCS code Q9975
Added: Q0181 for billing rolapitant on or after 09/02/2015
KX, GA AND GZ MODIFIERS:
Added: Rolapitant (Q0181) to guidelines
Added: J8655 to guidelines

Revision Effective Date: 07/01/2015 (August Publication)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Date information regarding code use, clerical error

Revision Effective Date: 07/01/2015
HCPCS CODES:
Added: HCPCS code Q9978
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Q9978 to modifier billing instructions effective 07/01/2015

Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
Revised: 3-drug combination coverage - Akynzea® (netupitant with palonosetron) NK-1/5HT3 antagonist available - effective on and after 10/10/2014
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Akynzeo® to the 3-drug combination billing and modifier instructions, effective on and after 10/10/2014

Revision Effective Date: 10/01/2014
Added: Other Jurisdictions

Revision Effective Date: 10/01/2014
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Statement noting that Aprepitant is currently the only FDA approved NK-1 antagonist
DOCUMENTATION REQUIREMENTS:
Added: Statement about adding Z51.11 to each claim for codes J8501 and Q0181.