Billing and Coding Guidelines for Drugs and Biologics (Non ...

Billing and Coding Guidelines for Drugs and Biologics (Non-chemotherapy) L 34741 Medicare Excerpts: CMS 100-02, Medicare Benefit Policy Manual, Chapter 15- Section 50 - Drugs and Biologicals: - Determining Self-Administration of Drug or Biological (Rev. 157, Issued: 06-08-12, Effective: 07-01-12, Implementation: 07-02-12) The Medicare program provides limited benefits for outpatient prescription Drugs . The program covers Drugs that are furnished incident to a physician s service provided that the Drugs are not usually self-administered by the patients who take them. Contractors must continue to apply the policy that not only the drug is medically reasonable and necessary for any individual claim, but also that the route of administration is medically reasonable and necessary.

Coding Guidelines 1. Diagnosis codes must be listed to the most specific number. ... Office/Clinic: ... The 2016 Physician Fee Schedule Final Rule, updated the regulation text found at 42 CFR 414.904(j) to make clear that effective January 1, 2016, the payment amount for a biosimilar biological drug ...

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