Traditional MedicareCoverageMedium impact
Off-label Use of Rituximab and Rituximab Biosimilars
Medicare/CMS - LCD·Oncology, Rheumatology, Hematology +1 more·Local Coverage Determination
Effective date
Jul 30, 2026
We identified it
Jul 31, 2026
Summary
This is a new Local Coverage Determination (LCD L38920) from CGS Administrators establishing coverage policy for off-label use of Rituximab and Rituximab Biosimilars under Medicare Part A and Part B. The policy becomes effective 7/30/2026 and requires billing teams to understand which off-label indications are covered and any associated documentation or prior authorization requirements.
Action Required
By July 29, 2026: Billing team must obtain and review the full policy text from the CMS Medicare Coverage Database (LCD L38920, version 16) to identify: (1) which off-label Rituximab/Rituximab Biosimilar indications are covered, (2) applicable HCPCS drug codes (likely J9310, J9311, or biosimilar equivalents), (3) any prior authorization requirements, and (4) required clinical documentation. Update billing software rules, encounter templates, and staff training to reflect coverage determinations. Communicate findings to providers and coding staff. Claims submitted without compliance to this LCD may be denied by CGS-administered Medicare plans in their jurisdiction.