Pharmacy Question for the Week of November 5, 2018

Pharmacy Compliance Question of the Week

Question:

How does Medicare determine payment for a code that isn’t in either the ASP or NOC drug-pricing files?

Answer:

When codes aren’t listed in these files, Medicare Administrative Contractors (MACs) will determine the payment allowance limits in accordance with the policy described in the Medicare Claims Processing Manual, Chapter 17, Section 20.1.3 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.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.