Program_Memos / 2000 / AB-00-110

Why This Topic Matters

It clarifies how a federal payment rule is to be applied in Medicare processing and identifies the manual sections being replaced. This matters for organizations that handle drug and biological reimbursement and need to keep payment procedures aligned with current CMS instructions.

Article Sections

1. Purpose

   Introduces the memorandum and the regulatory basis for the update. It frames the payment guidance that follows.

2. Payments for Drugs and Biologicals

   Summarizes the general reimbursement approach for certain drugs and biologicals and references commonly used pricing sources. It also notes examples of settings where the guidance applies.

3. Calculation of the AWP

   Outlines the general process used to determine the average wholesale price for different product types. It addresses how the payment allowance limit is derived.

4. Intermediary Processed Claims

   Describes how intermediary claim processing is to be handled and how drug payment allowance updates are distributed. It also addresses carrier and regional office coordination.

5. Manual Revisions and Implementation

   Identifies the manual provisions being replaced and notes the expected timing for revisions and retention of the memorandum. It also includes administrative implementation information.