Chemotherapy Administration

Reimbursement Policy:
Chemotherapy Administration

Effective Date:
August 1, 2007

Last Revised Date:
July 21, 2014

Purpose:
To provide guidelines for the reimbursement of the administration of chemotherapy.

Scope:

All products are included, except products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).

All Insured and Administrative Services Only (ASO) accounts are included.

Policy:
Horizon reimburses professionals for both 96413 and 96416 when billed together.

Procedure:
Reimbursement will be considered separately for CPT codes 96413 and 96416.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

History:
7/21/2014: Added CPT nomenclature statement.

CPT® is a registered mark of the American Medical Association

Policy 011_v1.0_07012014