Pharmacy Question for the Week of January 21, 2019

Pharmacy Compliance Question of the Week


What code should be reported to MACs for practitioner services for oral immunosuppressive, oral anticancer, and oral anti-emetic drugs?


Practitioners providing these medications to patients must bill the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), rather than the Part A/Part B MACs, using the National Drug Codes (NDC). A/B MACs do not pay codes for these oral medications when submitted on practitioner claims.

As stated in the National Correct Coding Initiative Manual for Medicare Services, the medically unlikely edit (MUE) values for outpatient hospital services are based on the amount of drug that might be administered to a patient on a single date of service (DOS). Facilities may not report to the A/B MAC more than a one day supply of any of these drugs for a single DOS. Outpatient hospital facilities may submit claims to DME MACs for a multiple day supply of these drugs provided on a single DOS.

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.