(Medicare Claims Processing Manual)

Medicare Claims Processing Manual Chapter 17 - Drugs and Biologicals Crosswalk New Chap New Sect Int. Pub. 13 Carrier Pub 14. SNF Pub 12 Other Source Description 17                                             10 B3-2049,B3-5201   A-00-36, B-01-10,  B-01-38, AB-01-16,  A-02-129, AB-02-174, AB-03-014 Payment Rules for Drugs and Biologicals  17 20 B3-5202,R1799B3 AB-02-075,PRM 2711.2 B. 2 Payment Allowance Limit for Drugs and Biologicals  17 20.1    AB-02-075, B-03-059,  AB-03-047,  PRM 2711.2 B. 2 Single Drug Pricer (SDP)  17 20.2 B3-5202.1 AB-02-075,PRM 2711.2 B. 2 Calculation of the AWP  17 20.3 B3-5202.1 AB-02-075,PRM 2711.2 B.2 Detailed Procedures for Determining AWPs and the Drug Payment Allowance Limits  17 20.3.1  Background  17 20.3.2 AB-02-075,PRM 2711.2 B. 2 Review of Sources for Medicare Covered Drugs and Biologicals 17 20.3.3 AB-02-075,PRM 2711.2 B. 2 Use of Generics   New Chap New Sect Int. Pub. 13 Carrier Pub 14. SNF Pub 12 Other Source Description 17                                                                                  20.3.4 AB-02-075,PRM 2711.2 B. 2 Find the Strength and Dosage  17 20.3.5 AB-02-075,PRM 2711.2 B. 2 Restrictions  17 20.3.6 AB-02-075,PRM 2711.2 B. 2 Inherent Reasonableness for Drugs and Biologicals  17 20.3.7 B3-5202.2 Injection Services  17 20.3.8 B3-5202.3 Injections Furnished to ESRD Beneficiaries  17 30 B3-5202.1 AB-02-075,PRM 2711.2 B. 2 Carrier Distribution of Limit Amounts  17 40  AB-02-075,PRM 2711.2 B. 2 Discarded Drugs and Biologicals  17 50 B3-5247 PM B-01-15 Assignment Required for Drugs and Biologicals  17 60 PM B-01-02 DMEPOS Suppliers Require a License to Dispense Drugs  17 60.1 B3-4118 Prescription Drugs Billed by Suppliers Not Licensed to Dispense Them 17 70    Staff developed-No Xref Claims Processing Requirements - General  17 70.1 B-03-041 Billing Drugs Electronically - NCPDP  17 70.1.1 B-03-057 Reporting Modifiers in the Compound Drug Segment  17 70.1.2 B-03-057 Coordination of Benefits (COB)   New Chap New Sect Int. Pub. 13 Carrier Pub 14. SNF Pub 12 Other Source Description 17                                          70.1.3 B-03-057 Inbound NCPDP Claim  17 80    Title+Xref-Not in manual Claims Processing for Special Drug Categories  17 80.1 A3-3660.13 SNF 536.1 Oral Cancer Drugs  17 80.1.1 A3-3660.13 SNF 536.1 HCPCS Service Coding for Oral Cancer Drugs  17 80.1.2 A3-3660.13 SNF 536.1 HCPCS and NDC Reporting for Prodrugs  17 80.1.3 A3-3660.13 SNF 536.1 Other Claims Processing Issues for Oral Cancer Drug  17 80.1.4 A3-3660.13 SNF 536.1 MSN/ANSI X12N Message Codes for Oral Cancer Drug Denials  17 80.2 A3-3660.15  B3-4460  PM A-98-5 Oral Anti-Emetic Drugs Used as Full Replacement for Intravenous Anti-Emetic Drugs as Part of a Cancer Chemotherapeutic Regimen  17 80.2.1 A3-3660.15  B3-4460  PM A-98-5 HCPCS Codes for Oral Anti-Emetic Drugs  17 80.2.2 A3-3660.15  B3-4460  PM A-98-5 Claims Processing Jurisdiction for Oral Anti-Emetic Drugs  17 80.2.3 A3-3660.15  B3-4460  PM A-98-5 MSN /ANSI X12N Denial Messages for Anti-Emetic Drugs 17 80.3  B3-4471   PM AB-01-10 Billing for Immunosuppressive Drugs  17 80.3.1 A3-3660.8 Requirements for Billing FI for Immunosuppressive Drugs  New Chap New Sect Int. Pub. 13 Carrier Pub 14. SNF Pub 12 Other Source Description 17                                                     80.3.2 MSN/Remittance Messages for Immunosuppressive Drugs  17 80.4  B3-5245   PM AB-00-117,  AB-03-014 Billing for Hemophilia Clotting Factors  17 80.5 A3-3660.11,A3-3660.12   SNF 536.1 PM AB-02-72 Self-Administered Drugs  17 90 Title-No Xref Claims Processing Rules for Hospital Outpatient Billing and Payment 17 90.1 PM-A-00-42,A-00-61, A-01-50 Blood/Blood Products and Drugs Classified in Separate APCs for Hospital Outpatients 17 90.2 A-02-026 Changes to Pass-Through Drugs and Biologicals Final Rule 17 90.2.1    PM A-02-026, IX.A HCPCS Codes Replacements  17 90.2.2 PM-A-02-026 IX.B  Codes Not Recognized for Medicare Under the Hospital OPPS 17 90.2.3 PM-A-02-026 IX.C  Additional Drugs Eligible for Pass-Through Payments 17 90.2.4 PM-A-02-026 IX.D  Changes to Payment Rates and Co-Pay From the March 1, 2002 OPPS Final Rule 17 90.2.5 PM-A-02-026 IX.E  Additional Corrections 17 90.2.6 PM-A-02-026 IX.F  Additional Billing and Reporting Information Related to Pass-Through Drugs Effective April 1, 200  New Chap New Sect Int. Pub. 13 Carrier Pub 14. SNF Pub 12 Other Source Description 17               90.2.7 PM-A-02-026 IX.G  Typographical Errors from the March 1, 2002, OPPS Final Rule 17 90.2.8 PM-A-02-026 IX.H  Correction to 2003 HCPCS Code Books 17 90.2.9 PM-A-02-026 X  Pro-Rata Reduction in Drug and Device Pass-Through Payments