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Oncology & Hematology Coding Alert

Reader Question:

Medicare Doesn't Reimburse Gleevec

Published on Sat Oct 18, 2003

Question: What documentation should we use to support our oncologist's off-label use of Gleevec to treat a Medicare patient's gastrointestinal stromal tumor (GIST)?

New York Subscriber Answer: Medicare will not reimburse Gleevec, which is an oral chemotherapy medication. But you may receive payment if the patient's insurer covers prescriptions.
 
You should call the carrier to verify coverage conditions, payment and any special billing requirements.
 
Typically, your documentation should include multiple sources. Examples include peer-review journals, such as the Journal of Clinical Oncology, or sources presented at peer-review meetings, such as the American Society of Clinical Oncology (ASCO) annual meeting.
 
Keep a file of current literature so you can easily copy materials and forward them to insurance agencies with the claim.
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