New Q code for VARUBI (rolapitant) effective 7/1/2016

• June 14, 2016
• Administrative, Clinical Practice Updates, Drugs

As you likely know, CMS has a National Coverage Determination policy outlining when to bill under Medicare Part B vs Part D when using oral anti-emetic therapies.  Under these policies, providers should bill under Part B only when specific criteria are met, including that the oral anti-emetics are used “as full replacement for the anti-emetic therapy which would otherwise be administered intravenously.”

In an effort to ensure you have accurate information about billing VARUBI® (rolapitant) under Medicare Part B, FLASCO wanted to communicate some news.   CMS has established a new Q code specifically for VARUBI.  This code will be required beginning July 1st, 2016 if you are billing oral VARUBI under Medicare Part B.  The new Q code for VARUBI will be Q9981 and should be used when billing Medicare Part B for dates of service between July 1, 2016 to December 31, 2016.  The unit of measure is 1 mg and one dose of VARUBI is 180 units (1 mg x 180 mg dose = one dose of VARUBI.)

For dates of service after June 30th, please discontinue the use of Q0181 when billing oral VARUBI under Medicare Part B.  Effective July 1st, please begin using Q9981.

There is no change to the billing process for VARUBI under Medicare Part D.