Transitional Pass-Throughs for Designated Drugs or Biologicals

40.5 - Transitional Pass-Throughs for Designated Drugs or Biologicals (Rev. 3941; Issued: 12-22-17; Effective: 01- 01-18; Implementation: 01-02-18) Certain current designated drugs and biologicals are assigned to special APCs. I/OCE identifies these and assigns the appropriate APC. Fiscal Intermediary Shared System (FISS) establishes payment at the average sales price (ASP) drug fee amount minus the portion of the otherwise applicable APC payment amount. I/OCE and FISS will determine the proper payment amount for these APCs as well as the coinsurance and any applicable deductible. All related payment calculations will be returned by the I/OCE and FISS, identified as a designated drug and biological with status indicator (SI) “K”. Certain new designated drugs and biologicals may be approved for payment, and their payment will be calculated in the same manner as listed above for current designated drugs and biologicals. IOCE identifies these new designated drugs and biologicals (SI “G”) separately from the current designated drugs and biologicals (SI “K”). Note: See section 40.1 for the I/OCE instructions and specifications