Local Coverage DeterminationOncology

LCD L38920: Off-label Use of Rituximab and Rituximab Biosimilars — CGS

LCD-L38920

Document details

Document type
Local Coverage Determination
Issuing body
MAC Contractor
Document ID
LCD-L38920
Published
June 5, 2026
Effective date
August 7, 2025
MAC region
CGS Administrators

Summary

The off-label use of Rituximab and its biosimilars may lead to increased scrutiny during the billing process, as insurers may require more documentation to justify its medical necessity. Providers sho

Prepare for billing changes on Rituximab off-label use.

Affected codes

ICD-10-CM

Affected specialty

Oncology alerts →

Source document

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38920&ver=15

CLV Intelligence summarizes publicly available federal publications. Not affiliated with or endorsed by any government agency.

Related alerts

4

FDA Approval: TRELSTAR (TRIPTORELIN PAMOATE) — Type 3 - New Dosage Form

Policy FDA-NDA022437 · Oncology

Critical

Trelstar (triptorelin pamoate) is an intramuscular injectable GnRH agonist indicated for advanced prostate cancer, billing under Medicare Part B as a physician-administered drug. As an established inj

View alert

FDA Approval: TRELSTAR (TRIPTORELIN PAMOATE) — Type 3 - New Dosage Form

Policy FDA-NDA021288 · Oncology

Critical

Trelstar (triptorelin pamoate) is an intramuscular injectable approved for a new dosage form under NDA021288, placing it firmly in the Medicare Part B billing pathway as a physician-administered drug.

View alert

FDA Approval: TRELSTAR (TRIPTORELIN PAMOATE) — Type 1 - New Molecular Entity

Policy FDA-NDA020715 · Oncology

Critical

Trelstar (triptorelin pamoate) is an intramuscular injectable indicated for prostate cancer, placing it squarely in the Medicare Part B billing pathway as a physician-administered drug. It is typicall

View alert

FDA Approval: ROMVIMZA (VIMSELTINIB) — Type 1 - New Molecular Entity

Policy FDA-NDA219304 · Oncology

High

Romvimza (vimseltinib) is an oral capsule kinase inhibitor approved via NDA219304, placing it squarely in the Medicare Part D billing pathway as a self-administered outpatient drug. As a new molecular

View alert