Drugs

70 - Drugs (Rev. 1, 10-01-03) SNF-536, SNF 536.1 Drugs and biologicals furnished to outpatients for therapeutic purposes that are self- administered are not covered by Medicare unless those drugs and biologicals must be put directly into an item of durable medical equipment or a prosthetic device. Exceptions to this rule are: • Self administered drugs administered in an emergency situation; • Self-administered oral versions of covered injectable cancer drugs prescribed as an anti-cancer chemotherapeutic; • Self-administered anti-emetic drugs; • Oral anti-emetic drugs as full therapeutic replacements for intravenous dosage forms as part of a chemotherapeutic regimen provided that the drug(s) be administered or prescribed by a physician for use immediately before, at, or within 48 hours after the time of administration of the chemotherapeutic agent; and • Immunosuppressive drugs furnished to transplant patients. See the Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Services," §§50 for coverage of drugs. See the Medicare Claim Processing Manual, Chapter 17, "Drugs," §§80 for billing and payment instructions. Where covered under Part B, self administered drugs for SNF inpatients not entitled to Part A benefits should be billed using type of bill 22X, and for SNF outpatients, using type of bill 23X.