Chemotherapy drugs, Medicare

Applies to:

Priority Health Medicare plans

Definition:

Chemotherapy drugs are used to treat cancer.

A chemotherapy drug is considered a Part B drug under both Original Medicare and Priority Health Medicare Advantage plans.

Our Medicare Advantage plans cover chemotherapy drugs obtained in a provider's office or facility whether the provider participates in the patient's plan or not.

  • The member's cost share is 20% coinsurance.
  • In-network providers: Some plans have in-network deductibles.
  • Out-of-network providers: Out-of-network deductible applies. Members should use a Medicare-participating provider to receive the best benefit at this level.

Chemotherapy drug authorizations

Some drugs require prior authorization. Search for the drug by name on this website to find the correct form.

Chemotherapy drug billing under Medicare

Direct billing

Providers may collect the 20% coinsurance at time of service or bill the member for it (Medicare Claims Processing Manual, Chapter 1, €30.3.1).

Providers may not bill for or try to collect any additional part of the bill from the member until the provider receives the Priority Health Medicare Remittance Advice (Medicare Claims Processing Manual, Chapter 1, €30.3.3).

Learn more

Get more details about billing chemotherapy drugs from: