Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.14
No Dollar Limits on Provision of Part B Drugs
10.14 – No Dollar Limits on Provision of Part B Drugs
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
No dollar limits may be placed on the provision of Part B drugs covered under original
Medicare unless the Medicare statute imposes the limit on original Medicare coverage, it
is specified in a national or applicable local coverage determination, or CMS imposes a
dollar limit. (See section 90.2 below for more detailed guidance on the obligation of plans
to follow local coverage determinations.)