decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Advance Beneficiary Notice / ABN not needed for self-injectable drugs
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Article Overview
This article reviews a Medicare policy update concerning self-injectable drugs and when an advance beneficiary notice is not required. It is aimed at coders, billing staff, and providers who need a general understanding of Medicare’s coverage approach, carrier notice expectations, and how related public information is communicated.
Why This Topic Matters
It helps billing and coding professionals understand when patient notice is not required for certain excluded drugs and what carrier-level documentation and notice practices are expected.
What You Will Learn
- How Medicare treats self-injectable drug coverage exclusions
- When advance beneficiary notice requirements are discussed in relation to these drugs
- What carrier notice and website information is expected under the policy
- How FDA labeling relates to the coverage determination at a high level
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Compliance staff
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