REVISED: Coding—New Oral Antiemetic Drug Akynzeo®
Date Issued: 1/19/2016
Akynzeo® (Q0181 or Q9978), an FDA approved combination medication used to treat nausea and vomiting in patients undergoing cancer chemotherapy, must be billed on the same claim with dexamethasone (J8540) to qualify for consideration of coverage. There must be no unbundling of the netupitant and palonosetron combination in Akynzeo®.
Claim lines billed without a KX, GA or GZ modifier will be rejected as missing information.
See the table below for billing instructions:
|Billing Instruction for Date of Service
||Healthcare Common Procedure Coding System (HCPCS) Code
|Prior to July 1, 2015
|| Q0181 – Unspecified oral dosage form, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
|On or after July 1, 2015
||Q9978 – Netupitant palonosetron oral netupitant 300 MG and palonosetron 0.5 MG, oral
|On or after January 1, 2016
||J8655 - Netupitant 300 MG and palonosetron