Oncology
View all Oncology-related articles >>
Spotlight
- NCD 110.24: Chimeric Antigen Receptor (CAR) T-cell therapy
Effective for dates of service on or after August 7, 2019, Medicare will pay claims from approved providers for administration of autologous T-cells expressing at least one CAR for the treatment for cancer. This article was updated January 7, 2025, to update some HCPCS codes with current CPT codes for CY 2025. - View CMS Newsroom Center (Spotlights, news, media releases, outreach, mailing lists, etc.)
- CMS Quarterly Provider Updates (QPU)
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
- Excluded Cancer Hospitals – Cancer hospitals excluded from the acute inpatient prospective payment system (IPPS)
- Devices and clinical trials
- Medicare Approved Facilities / Trials / Registries
- Includes the National Oncologic PET Registry
- CLIA approved proficiency testing programs
LCD / NCD
LCDs
Search for oncology-related LCDs using these available tools:
- Interactive LCD index tool
- Include radiation therapy LCDs, for example Intensity Modulated Radiation Therapy (IMRT) (L36773), an LCD of recent focus.
- View First Coast’s active / proposed LCDs on CMS’ Medicare coverage database (MCD)
NCDs
Search for oncology-related NCDs using these available tools:
- Search CMS’ MCD
- CMS’ MCD - NCD alphabetical index
- National Medicare coverage documents:
Audit and compliance
- CERT resources
- Recovery Auditor (RA) resources
- Incident-to tool -- identify the appropriate application of incident-to requirements
- Appropriate Use Criteria for Advanced Diagnostic Imaging -- Voluntary Participation and Reporting Period -- Claims Processing Requirements -- HCPCS Modifier QQ (MM10481)
- Appropriate Use Criteria for Advanced Diagnostic Imaging--Fact Sheet (ICN 909377)
- Provider Compliance Tips for Immunosuppressive Drugs (ICN 909466)
- Provider Compliance Tips for Laboratory Tests – Blood Counts (ICN 909481)
- Complying with Documentation Requirements for Laboratory Services (ICN 909221)
- Office of Inspector General (OIG) Report -- Medicare Improperly Paid Hospitals Millions of Dollars for Intensity-Modulated Radiation Therapy Planning Services (A-09-16-02033)
Frequently asked questions (FAQs)
Before you call the First Coast provider contact center, find answers to frequently-asked questions about coding or billing oncology-related services within these FAQs.
Oncology services education
Utilize educational information from First Coast and CMS on oncology services.
- Upcoming events
- Visit On-Demand Learning – access First Coast’s webcast recordings, web-based training, videos and tutorials.
CMS educational opportunities
CMS internet-only manual (IOM)
The CMS IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives.
The following CMS manuals contain information specific to oncology services:
- Chapter 15 of the Medicare Benefit Policy Manual
- Chapter 12 of the Medicare Claims Processing Manual
- Chapter 13 of the Medicare Claims Processing Manual
- Chapter 17 of the Medicare Claims Processing Manual
- Chapter 1 of the Medicare National Coverage Determinations Manual, Pub. 100-03, Chapter 1, Part 2
Resources
Visit the Physician Center on the CMS website.
View additional resources identified specifically for oncology services:
- CMS Medicare Coverage Database
- Professional associations
- General resources
Stay Informed
Subscribe
Stay updated on the latest Medicare information with free email subscriptions from First Coast and CMS.
View archives
Access previously published emails you may have missed.