(A) Provision of the chemotherapeutic agent.
When the chemotherapeutic agent is provided through the physician's office, physician's group practice, or clinic and is administered in a nonhospital setting, the physician may be reimbursed for the cost of the chemotherapeutic agent by billing the appropriate healthcare common procedure coding system (HCPCS) injection code.
(B) Reimbursement for chemotherapy administration is restricted to certain place of service settings as set forth in rule 5160-1-60 of the Administrative Code.
(1) The administration of chemotherapy includes the preparation of the chemotherapeutic agent and all therapeutic services and medical supplies provided during treatment.
(2) When chemotherapy is administered in the physician's office, group practice, or clinic, the physician may be reimbursed for chemotherapy treatments personally administered by the billing physician or by a qualified employee supervised by the billing physician. For reimbursement, the provider must bill the appropriate current procedural terminology (CPT) code for chemotherapy.
(3) The administration of chemotherapy is independent of the physician's professional service and the office visit. When a physician examines the patient, a visit may be billed in conjunction with the chemotherapy injection and administration codes (nonhospital setting only). The professional services involved in the supervision and monitoring of the chemotherapy treatments are considered a part of the evaluation and management (visit) service.
Five Year Review (FYR) Dates: 10/11/2016 and 12/31/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.02
Prior Effective Dates: 9/1/89, 5/1/90, 4/1/92 (Emer), 7/1/92, 3/30/95, 8/2/2011