decisionhealth Newsletters, Part B News - 2002 Issue 5 (May)
Carriers should soon cover more drugs you administer in your office
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Article Overview
This article covers a new CMS program memo that encourages Medicare carriers to revisit coverage of some injectable drugs administered in physician offices. It is relevant to coders, billers, and practice managers who need to understand broad coverage guidance, carrier discretion, and the administrative impact on payment for drug administration services. The article also discusses the agency’s non-national approach, carrier flexibility, and the general categories of factors CMS says carriers may consider when reviewing drug coverage.
Why This Topic Matters
Coverage policy for office-administered drugs can affect whether practices are paid for drug administration services. Understanding the scope of this CMS guidance helps billing staff anticipate carrier decisions and monitor changes in Medicare payment policy.
Article Sections
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CMS guidance on office-administered drugs
Introduces the CMS memorandum and the broader policy issue involving Medicare carrier coverage of certain drugs administered in a physician’s office. Summarizes the administrative context and why the topic is being revisited.
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How carriers are encouraged to evaluate drugs
Describes the general framework CMS encourages carriers to use when considering whether a drug is typically self-administered. Covers the broad categories of delivery route and patient-use considerations discussed in the memo.
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Limits on limited-dose and training-related coverage
Addresses the portion of the guidance dealing with situations where drugs are given in connection with patient instruction or short-term supervised use. Notes the article’s discussion of changing contractor payment practices in these settings.
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Next steps and rulemaking
Explains the agency’s plan to seek public comment through the federal rulemaking process. Covers the article’s closing discussion of how the guidance may be refined over time.
What You Will Learn
- The scope of CMS guidance on Medicare carrier coverage for office-administered drugs
- How the article frames carrier discretion in reviewing drug coverage
- What general factors CMS says may affect whether a drug is considered usually self-administered
- How the guidance may influence billing and reimbursement workflow in physician offices
- What the article says about CMS’s next procedural steps
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Physician practice managers
- Compliance staff
- Medicare-focused providers
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