Most chemotherapies can be safely administered in the oncologist's office, infusion centers or in the patient's home. Hospitalization for chemotherapy is now limited to specific situations, reflecting the need for prolonged direct observation, prevention or treatment of anticipated or real side effects, the use of special facilities and the minimization of certain treatment risks that can not be effectively dealt with in an outpatient setting.
Outpatient chemotherapy has the advantages of allowing safe, easy drug administration, respecting the patient's wish to avoid hospitalization and providing a familiar facility, which enhances the patient's physical comfort and psychological well-being.
The most common major complications of chemotherapy are bone marrow suppression, nausea and vomiting and inflammation of the oral mucosa (i.e., stomatitis). Emerging data suggest that prophylactic oral antibiotics (e.g., 500 mg of levofloxacin daily) reduce the number of hospitalizations in patients whose absolute neutrophil count falls below 1,000/mm3. Anti-emetic drugs should be given on a regular schedule to prevent nausea and vomiting. Topical oral anesthetics for the treatment of stomatitis may relieve pain and help maintain adequate oral intake.
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
96401 - 96549
99221 - 99239
HCPCS codes covered if selection criteria are met:
Injection, gallium nitrate, 1 mg
Methotrexate, oral, 2.5 mg
J9000 - J9999
Injection, teniposide, 50 mg
ICD-9 codes covered if selection criteria are met:
140.0 - 208.91, 230.0 - 234.9
Other ICD-9 codes related to the CPB:
270.0 - 279.9
Other metabolic and immunity disorders
390 - 459.9
Diseases of the circulatory system
460 - 519.9
Diseases of the respiratory system
580.0 - 593.9
Diseases of the genitourinary system
787.01 - 787.03
Nausea and vomiting
Adverse effects of antineoplastic and immunosuppressive drugs
V58.11 - V58.12
Encounter for antineoplastic chemotherapy and immunotherapy
The above policy is based on the following references:
Goroll AH, ed. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:570.
Peters WP, Ross M, Vredenburgh JJ, et al. The use of intensive clinic support to permit outpatient autologous bone marrow transplantation for breast cancer. Semin Oncol. 1994;21(4 Suppl 7):25-31.
Shaw HL. Treatment of the patient with cancer using parenteral electronic drug administration. Cancer. 1992;70 (suppl):993-997.
Figlin RA, Belldegrun A, Moldawer N, et al. Concomitant administration or recombinant human interleukin-2 and recombinant interferon alfa-2A: An active outpatient regimen in metastatic renal cell carcinoma. J Clin Oncol. 1992;10:414-421.
Skubitz K, Hamdan H, Thompson RC. Ambulatory continuous infusion ifosfamide with oral etoposide in advanced sarcomas. Cancer. 1993;72:2963-2969.
Close P, Burkey E, Kazak A, et al. A prospective, controlled evaluation of home chemotherapy for children with cancer. Pediatrics. 1995;95(6):896-900.
Holdsworth MT, Raisch DW, Chavez CM, et al. Economic impact with home delivery of chemotherapy to pediatric oncology patients. Ann Pharmacother. 1997;31(2):140-148.
Watters C. The benefits of providing chemotherapy at home. Prof Nurse. 1997;12(5):367-370.
Dougherty L, Viner C, Young J. Establishing ambulatory chemotherapy at home. Prof Nurse. 1998;13(6):356-358.
Westermann AM, Holtkamp MM, Linthorst GA, et al. At home management of aplastic phase following high-dose chemotherapy with stem-cell rescue for hematological and non-hematological malignancies. Ann Oncol. 1999;10(5):511-517.
Catania PN. Home chemotherapy: Basic concepts. Home Care Provid. 1999;4(2):60-61.
Berman AJ. Supporting the home care client receiving chemotherapy. Home Care Provid. 1999;4(2):81-87.
Rischin D, White MA, Matthews JP, et al. A randomised crossover trial of chemotherapy in the home: Patient preferences and cost analysis. Med J Aust. 2000;173(3):125-127.
King MT, Hall J, Caleo S, et al. Home or hospital? An evaluation of the costs, preferences, and outcomes of domiciliary chemotherapy. Int J Health Serv. 2000;30(3):557-579.
Borras JM, Sanchez-Hernandez A, Navarro M, et al. Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: A randomised controlled trial. BMJ. 2001;322(7290):826.
Santolaya ME, Alvarez AM, Aviles CL, et al. Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection. J Clin Oncol. 2004;22(18):3784-3789.
Boothroyd L, Lehoux P. Home-based chemotherapy for cancer. Issues for patients, caregivers and the health care system. AETMIS; 04-02. Montreal, QC; Agence D'Evaluation des Technologies et des Modes D'Intervention en Sante (AETMIS); May 2004.
Stevens B, Croxford R, McKeever P, et al. Hospital and home chemotherapy for children with leukemia: A randomized cross-over study. Pediatr Blood Cancer. 2006;47(3):285-292.
Löwenberg B, Pabst T, Vellenga E, et al; Dutch-Belgian Cooperative Trial Group for Hemato-Oncology (HOVON) and Swiss Group for Clinical Cancer Research (SAKK) Collaborative Group. Cytarabine dose for acute myeloid leukemia. N Engl J Med. 2011;364(11):1027-1036.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.