Pharmacy Question for the Week of April 30, 2018

Pharmacy Compliance Question of the Week

Question:

What is the proper way to bill Medicare for no-cost drugs since claims-processing edits prevent drug- administration charges from being billed when the claim does not contain a covered/billable drug charge?

Answer:

The best place to go for this answer is the Medicare Claims Processing Manual, Chapter 32—Billing Requirements for Special Services—section 67.2 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c32.pdf. Also, consult transmittal 4013 at
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4013CP.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.