Payment Policy - Chemotherapy Drugs and Services

Payment for chemotherapy drugs, administration and ancillary services (e.g., radiology and laboratory services) is HMSA's eligible charge less any member copayment and/or deductible.

HMSA's payment for chemotherapy administration is an all-inclusive rate that includes, but is not limited to, use of the room, associated medical/surgical supplies, routine and oral pharmacy items associated with chemotherapy administration, and professional services (including nonphysician) associated with intravenous, subcutaneous, or intra-muscular antineoplastic drug administration. Catheter flushing done at the time of the chemotherapy is also included in the all-inclusive rate and should not be billed separately.

Note: The all-inclusive rate can be billed for each day an HMSA member receives chemotherapy.

Payment for Off-day Service

Payment can be made for chemotherapy off-day service when the patient is scheduled for chemotherapy and has been prepared for the therapy, but a decision is made to postpone therapy to another day due to medical considerations (e.g., based on new test results). Payment also can be made for chemotherapy off-day service when a patient is not on active chemotherapy, but the patient has an access line that has been left in place and catheter flushing is done to maintain patency of the line.

Chemotherapy off-day service should not be billed if the patient is receiving injections, drawing blood for laboratory services or is receiving a therapy other than chemotherapy.

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