The Centers for Medicare & Medicaid Services (CMS) has identified an issue regarding payment for off-label drug usage for the anti-cancer and anti-emetic drugs submitted on a hospital bill as part of a chemotherapy course of treatment.

CMS has instructed providers to process for payment services for approved anti-cancer drugs submitted with the appropriate anti-emetic drug code until the implementation of the October 2008 quarterly release for the Medicare common working file (CWF) revised edits.

As of August 25, 2008, First Coast Service Options (FCSO) Inc. is automatically suspending claims receiving CWF edits C7245 or C7247 drugs to location S/MEMET. FCSO is performing a manual review of all the claims with charges for anti-cancer and anti-emetic. Claims that have been submitted correctly will be released for payment. Claims that were not billed correctly will be rejected based on the CWF edits C7245 or C7247 guidelines.

Providers that have received denied charges for off-label drug usage for the anti-cancer and anti-emetic drugs prior to August 25, 2008, may resubmit the claim as an adjustment.