Current through Vol. 42, No. 1, September 16, 2024
(a)
Outpatient.
(1) Outpatient
chemotherapy is compensable only when a malignancy is indicated or for the
diagnosis of Acquired Immune Deficiency Syndrome (AIDS). Outpatient
chemotherapy treatments are unlimited. Outpatient visits in connection with
chemotherapy are limited to four per month.
(2) Payment for administration of
chemotherapy medication is made under the appropriate National Drug Code (NDC)
and HCPCS code as stated in OAC
317:30-5-14(b).
Payment is made separately for office visit and administration under the
appropriate CPT code.
(3) When
injections exceed listed amount of medication, show units times appropriate
quantity, i.e., injection code for 100 mgm but administering 300, used 100 mgm
times 3 units.
(4) Glucose - fed
through IV in connection with chemotherapy administered in the office is
covered under the appropriate NDC and HCPCS code.
(b)
Inpatient.
(1) Inpatient hospital supervision of
chemotherapy administration is non-compensable. The hospital visit in
connection with chemotherapy could be allowed within our guidelines if
otherwise compensable, but must be identified by description.
(2) Hypothermia - Local hypothermia is
compensable when used in connection with radiation therapy for the treatment of
primary or metastatic cutaneous or subcutaneous superficial malignancies. It is
not compensable when used alone or in connection with chemotherapy.
(3) The following are not compensable:
(A) Chemotherapy for Multiple
Sclerosis;
(B) Efudex;
(C) Oral Chemotherapy;
(D) Photochemotherapy;
(E) Scalp Hypothermia during Chemotherapy;
and
(F) Strep Staph
Chemotherapy.
Added at 12 Ok Reg
751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
7-27-95; Amended at 18 Ok Reg 109, eff 10-7-00 (emergency); Amended at 18 Ok
Reg 1130, eff 5-11-01; Amended at 21 Ok Reg 501, eff 1-1-04 (emergency);
Amended at 21 Ok Reg 2176, eff 6-25-04; Amended at 25 Ok Reg 656, eff 1-18-08
through 7-14-08 (emergency)1; Amended at 25 Ok Reg
2660, eff 7-25-08
1This emergency action expired
on 7-14-08 before being superseded by a permanent action. Upon expiration of an
emergency amendatory action, the last effective permanent text is reinstated.
Therefore, on 7-15-08 (after the 7-14-08 expiration of the emergency action),
the text of 317:30-5-15 reverted back to the permanent text that became
effective 6-25-04, as was last published in the 2006 Edition of the OAC, and
remained as such until amended again by permanent action on
7-25-08.
