Federal (United States) · Agency guidance
Chapter 17
110 sections
110 sections
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 10Payment Rules for Drugs and Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 10.1Payment Rules for Drugs and Biologicals Subject to the Inflation-Adjusted
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20Payment Allowance Limit for Drugs and Biologicals Not Paid on a Cost or
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.1MMA Drug Pricing - Average Sales Price
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.1.1Online Pricing Files for Average Sales Price
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.1.2Average Sales Price (ASP) Payment Methodology
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.1.3Exceptions to Average Sales Price (ASP) Payment Methodology
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.2Single Drug Pricer (SDP)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.3Calculation of the Payment Allowance Limit for DME MAC Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.4Calculation of the AWP
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5Detailed Procedures for Determining AWPs and the Drug Payment
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.1Background
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.2Review of Sources for Medicare Covered Drugs and Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.3Use of Generics
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.4Find the Strength and Dosage
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.5Restrictions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.6Inherent Reasonableness for Drugs and Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.7Injection Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.8Injections Furnished to ESRD Beneficiaries
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.9Annual Update of AWP Payment Allowance Limit for Vaccines
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 30A/B MAC (B) Distribution of Limit Amounts
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 40Discarded Drugs and Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 40.1Discarded Erythropoietin Stimulating Agents for Home Dialysis
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 50Assignment Required for Drugs and Biologicals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 60DMEPOS Suppliers Require a License to Dispense Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 60.1Prescription Drugs Billed by Suppliers Not Licensed to Dispense Them
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70Claims Processing Requirements – General
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70.1Billing Drugs Electronically - NCPDP
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70.1.1Reporting Modifiers in the Compound Drug Segment
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70.1.2Coordination of Benefits (COB)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70.1.3Inbound NCPDP Claim
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 70.2Billing Zero Charges for Drug Line Items Provided at No Cost
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80Claims Processing for Special Drug Categories
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.1Oral Cancer Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.1.1HCPCS Service Coding for Oral Cancer Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.1.2HCPCS and NDC Reporting for Prodrugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.1.3Other Claims Processing Issues for Oral Cancer Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.1.4MSN/Claim Adjustment Message Codes for Oral Cancer Drug Denials
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.2Oral Anti-Emetic Drugs Used as Full Replacement for Intravenous Anti-
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.2.1HCPCS Codes for Oral Anti-Emetic Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.2.2Claims Processing Jurisdiction for Oral Anti-Emetic Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.2.3MSN Denial /Claim Adjustment and Remark Messages for Anti-Emetic
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.2.4Billing and Payment Instructions for A/B MACs (A)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.3Billing for Immunosuppressive Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.3.1Requirements for Billing A/B MAC (A) for Immunosuppressive
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.3.2MSN/Remittance Messages for Immunosuppressive Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.3.3Special Requirements for Immunosuppressive Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.4Billing for Hemophilia Clotting Factors
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.4.1Clotting Factor Furnishing Fee
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.5Self-Administered Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.6Intravenous Immune Globulin
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.7Pharmacy Supplying Fee and Inhalation Drug Dispensing Fee
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.8Reporting of Hematocrit and/or Hemoglobin Levels
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.9Required Modifiers for ESAs Administered to Non-ESRD
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.10Hospitals Billing for Epoetin Alfa (EPO) and Darbepoetin Alfa
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.11Requirement for Providing Route of Administration Codes for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.12Claims Processing Rules for ESAs Administered to Cancer
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 80.13Supplier Payment Under Medicare Part B for Insulin Furnished
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90Claims Processing Rules for Hospital Outpatient Billing and
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90.1Blood/Blood Products and Drugs Classified in Separate APCs for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90.2Drugs, Biologicals, and Radiopharmaceuticals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90.2.1HCPCS Codes Replacements
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90.3Hospital Outpatient Payment Under OPPS for New, Unclassified
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 90.4Hospital Billing For Take-Home Drugs
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100The Competitive Acquisition Program (CAP) for Drugs and
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.1Physician Election and Information Transfer Between A/B
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.1.1Physician Information for the Designated A/B MAC (B)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.1.1.1Quarterly Updates
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.1.2Format for Data
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.1.3Physician Information for the Vendors
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2Claims Processing Instructions for CAP Claims for the A/B
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.1CAP Required Modifiers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.2Submitting the Charges for the Administration of a CAP Drug
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.3Submitting the Prescription Order Numbers and No Pay
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.3.1Further Editing on the Prescription Order Number
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.4CAP Claims Submitted With Only the No Pay Line
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.5Use of the “Restocking” Modifier
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.6Use of the “Furnish as Written” Modifier
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.7Monitoring of Claims Submitted With the J2 and/or J3
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.8Claims Submitted for Only Drugs Listed on the Approved
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.9Submission of Claims With the Modifier JW, “Drug Amount
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.2.10MSP Situations Under CAP
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.3Application of Local Medical Review Policies
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4Claims Processing Instructions for the Designated A/B MAC (B)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.1Creation of Internal Vendor Provider Files
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.2Submission of Paper Claims by Vendors
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.3Submission of Claims from Vendors With the J1 No Pay
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.4Submission of Claims from Vendors Without a Provider
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.5New MSN Message to Be Included on All Vendor Claims
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.6Additional Medical Information
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.4.7CAP Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5Matching the Physician Claim to the Vendor Claim
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.1Denials Due to Medical Necessity
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.2Denials For Reasons Other Than Medical Necessity
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.3Changes to Pay/Process Indicators
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.4Post-Payment Overpayment Recovery Actions
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.5Pending and Recycling the Claim When All Lines Do Not Have
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.5.6Creation of a Weekly Report for Claims That Have Pended
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.6Coordination of Benefits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 100.7National Claims History