Medicare Claims Processing Manual (Pub. 100-04), Ch. 17 § 20.5.1
Background
20.5.1 - Background
(Rev. 397, Issued: 12-16-04, Effective: 01-01-05, Implementation: 01-03-05)
Payment for drugs and biologicals under Medicare is determined by a standard methodology. Law and
regulations require that a drug payment allowance limit be used as described in §20.1. (See 42 CFR
405.517 and MPDIMA, Section 303(b).)
The earliest drug payment allowance limit effective in 2004 will not be subsequently updated during 2004.
When limits are initially established, A/B MACs (B) inform A/B MACs (A) and the provider community
as described in paragraph §30 below.