Restrictions

20.5.5 - Restrictions (Rev. 397, Issued: 12-16-04, Effective: 01-01-05, Implementation: 01-03-05) To determine AWPs and Payment Allowance Limits, A/B MACs (B): • Exclude special sized packaging, e.g., Institutional Use. • Do not use flip top vial, carpu-ject, tubes, cartridge, rapi-ject, lure lock syringe, blunt point abu- ject, rapi-ject, leurlock, advantage, min-i-jet, unless it is the only source available. These items are considered convenience and tend to inflate the price. • Do not use drugs marked preservative free, sulfite free, piggy back, or sterile unless the HCPCS description specifies otherwise. • Do not use drugs with an Orange Book Code (OBC) other than “A” if more than one source exists. This restriction applies to SADMERC only (reference CMS Memorandum PUB 60 AB.94-2, 60 dated March 1994).