Local Coverage Determination · DME MAC
L33827
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
Version 55. 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. Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 110.18
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. The use of the oral anti-emetic 3-drug combination of an FDA approved oral NK-1 antagonist in combination with an oral 5HT3 antagonist and dexamethasone (J8540) is covered if, in addition to meeting the statutory coverage criteria specified in the related Policy Article, they are administered to beneficiaries who are receiving one or more of the following anti-cancer chemotherapeutic agents: If the NK-1 antagonist, 5HT3 antagonist and dexamethasone 3-drug combination meet the statutory coverage criteria, but are not used with one of the preceding chemotherapeutic agents, they will be denied as not reasonable and necessary.
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
- A52480 · Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
Related NCDs
- NCD 110.18 · Aprepitant for Chemotherapy-Induced Emesis (version 2)
HCPCS codes on this LCD
18 other Level II codes are on the LCD and are not given a page in this set: J8540, J8655, J8670, Q0155, Q0161, Q0162, Q0163, Q0164, Q0166, Q0167, Q0169, Q0173, Q0175, Q0177, Q0180, Q0181, Q0511, Q0512.
Questions
What does LCD L33827 cover?
L33827 is Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics). It is a current final DME MAC local coverage determination, version 55.
Where is the CMS source for L33827?
The Medicare Coverage Database page for LCD L33827 version 55.
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=J8501&as_of=2024-01-15&npi=1234567890&state=UT"