Capecitabine Oral Anti-Cancer Drug Billing Instructions

These instructions apply to Capecitabine Oral Anticancer Drugs billed under the Oral Anticancer Drugs Local Coverage Determination (LCD L33826)External Link:

  • Dates of service October 1 – December 31, 2024 (J8520 and J8521):
    • Bill these drugs with HCPCS code J8999 (Prescription drug, oral, chemotherapeutic, NOS)
    • Do not bill these drugs using the National Drug Code (NDC)
    • Claim narrative field: Drug name (Capecitabine or Xeloda) Dosage, and National Drug Code (NDC)
      • Electronic Claims: NTE 2300 or NTE 2400 narrative segment field
      • Paper Claims (CMS-1500 Claim Form): Item 19
  • Dates of service on or after January 1, 2025, follow the LCD for billing Oral Anti-Cancer Drugs:
    • Bill these drugs with the NDC reported in the 2410 LIN segment.
    • When the National Drug Code (NDC) does not have an assigned HCPCS, the 2400 SV101-1 should contain the value ‘HC’ and the 2400 SV101-2 should contain the value of ‘S5000’ (generic NDC) or ‘S5001’ (name brand NDC).

The NDC is a number which uniquely identifies a manufacturer's product in terms of the strength of each tablet, quantity of tablets in a package, and other packaging details. Suppliers must use the NDC that matches the product dispensed. Do not use HCPCS J codes for capecitabine prescribed for use as an oral anti-cancer drug for dates of service on or after January 1, 2025.
 
For questions about correct coding, contact the PDACExternal Link.

Post Date: 11/05/2025