Local Coverage Determination · DME MAC
L33826
Oral Anticancer Drugs
Version 22. CMS effective date 01/01/2026. CMS updated 12/31/2025. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Benefits Policy Manual (IOM 100-02), Chapter 15, Section 50 - Drugs and Biologicals Social Security Act, Sec. 1861(s)(Q)
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Statutory coverage criteria for oral anticancer drugs are specified in the related Policy Article. In addition, the drug must be reasonable and necessary for the individual beneficiary. If the statutory coverage criteria are met but the drug is not reasonable and necessary for the individual beneficiary it will be denied as not medically necessary. Drugs may be covered only if dispensed and billed to Medicare by the entity that actually dispenses the drug to the Medicare beneficiary, and that entity must be permitted under all applicable federal, state, and local laws and regulations to dispense drugs.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52479 · Oral Anticancer Drugs - Policy Article
HCPCS codes on this LCD
5 other Level II codes are on the LCD and are not given a page in this set: J8498, J8597, J8999, Q0511, Q0512.
Questions
What does LCD L33826 cover?
L33826 is Oral Anticancer Drugs. It is a current final DME MAC local coverage determination, version 22.
Where is the CMS source for L33826?
The Medicare Coverage Database page for LCD L33826 version 22.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A9270&as_of=2024-01-15&npi=1234567890&state=UT"