Medicare billing codes (by regimen for EMEND)

Oral EMEND may be covered under Medicare Part B or Medicare Part D. Whether Part B or Part D provides coverage depends, in part, on the regimen with which oral EMEND is dispensed. Please refer to detailed information about Medicare Part B and Medicare Part D coverage for EMEND.

EMEND for Injection (Day 1) and Oral EMEND (Day 2 + Day 3)
Product/Description	NDC	HCPCS/CPT Codea	HCPCS/CPT Code Description	Standard Billing Unit	Bill To
EMEND for Injection See also: Administration codeb	0006-3884-32	J1453	Injection, fosaprepitant, 1 mg	115	Medicare Part B
Bifold pack of EMEND (Two 80-mg capsules) 2 EMEND 80-mg capsules	0006-0461-02 00006-0461-06	J8501	Aprepitant, oral, per 5 mg	32	Medicare Part D (specifics apply: - see oral coverage for Part D)

Trifold Pack of Oral EMEND Used With an Oral 5 HT3 and Oral Dexamethasone
Product/Description	NDC	HCPCS/CPT Codea	HCPCS/CPT Code Description	Standard Billing Unit	Bill To
Trifold pack of EMEND (One 125 mg capsule and two 80-mg capsules)	0006-3862-03	J8501	Aprepitant, oral, per 5 mg	57	Medicare Part B (specifics apply: - see oral coverage for Part B)

Oral EMEND Used With an Oral 5-HT3 and Oral Dexamethasone
Product/Description	NDC	HCPCS/CPT Codea	HCPCS/CPT Code Description	Standard Billing Unit	Bill To
Oral EMEND (One 125 mg capsule)	0006-0462-06	J8501	Aprepitant, oral, per 5 mg	25	Medicare Part B (specifics apply: - see oral coverage for Part B)
Bifold pack of EMEND (Two 80-mg capsules) 2 EMEND 80-mg capsules	0006-0461-02 00006-0461-06	J8501	Aprepitant, oral, per 5 mg	32	Medicare Part B (specifics apply: - see oral coverage for Part B)

Tri-fold Pack of Oral EMEND Used With Other I.V. antiemetics
Product/Description	NDC	HCPCS/CPT Codea	HCPCS/CPT Code Description	Standard Billing Unit	Bill To
Trifold pack of EMEND (One 125 mg capsule and two 80-mg capsules)	0006-3862-03	J8501	Aprepitant, oral, per 5 mg	57	Medicare Part D (specifics apply: - see oral coverage for Part D)

Oral EMEND Used With Other I.V. antiemetics
Product/Description	NDC	HCPCS/CPT Codea	HCPCS/CPT Code Description	Standard Billing Unit	Bill To
Oral EMEND (One 125 mg capsule)	0006-0462-06	J8501	Aprepitant, oral, per 5 mg	25	Medicare Part D (specifics apply: - see oral coverage for Part D)
Bifold pack of EMEND (Two 80-mg capsules) 2 EMEND 80-mg capsules	0006-0461-02 00006-0461-06	J8501	Aprepitant, oral, per 5 mg	32	Medicare Part D (specifics apply: - see oral coverage for Part D)

Information About Medicare Part B and Part D coverage for EMEND

Suggested prescription documentation

^aCPT copyright 2007 American Medical Association. All rights reserved.
CPT^® is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

^bAdministration code: The appropriate CPT code is 96375 — therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure).

Hospital billing of take-home drugs

Medicare policy
Effective July 1, 2006, the Centers for Medicare & Medicaid Services (CMS) implemented a policy on hospital outpatient billing for take-home oral antiemetics. Please refer to the following document for full policy information:

CMS Manual System, Pub 100-04, Medicare Claims Processing, Transmittal 840
[PDF: 50 KB, 12 Pages]

Changes resulting from the Medicare policy

For use of EMEND meeting Medicare Part B National Coverage Determination for Aprepitant:

• When dispensing the trifold pack (NDC 0006-3862-03) of EMEND, it can be billed in its entirety through the fiscal intermediary (FI) or A/B MAC. No supplying fee would apply to drugs billed to the FI or A/B MAC.

• When dispensing the initial dose of EMEND as an oral 125 mg capsule (NDC 0006-0462-06) during the outpatient visit, it can be billed to the FI or A/B MAC.

  When dispensing the take-home portion (Day 2 and Day 3) as two 80 mg capsules (NDC 0006-0461-06) or the bifold pack (NDC 0006-0461-02), the 80 mg capsules are billed to the appropriate DME MAC with the associated supplying fees. (Additional billing requirements may be provided by the DME MAC.)

  When billing the DME MAC, supplying fees must be billed on the same claim as the drug.

For more information, see the National Coverage Determination for Aprepitant.

EMEND is given for 3 days as part of a regimen that includes a corticosteroid and a 5-HT₃ receptor antagonist. The recommended dosage includes EMEND 125 mg (orally 1 hour before chemotherapy) on treatment Day 1 followed by EMEND (80 mg) once daily on Days 2 and 3.

Before prescribing EMEND or EMEND for Injection, please read the Prescribing Information. The Patient Information also is available.

Sample UB-04 claim form

View or download a sample UB-04 form.

Sample UB-04 claim form
[PDF: 352 KB, 1 page]