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Drugs and Biologicals

Published 6/1/2016

Access guidance for submitting drugs and biologicals through the links below.

Reimbursement

Average Sales Price (ASP) and Not Otherwise Classified (NOC) Pricing Files
Wholesale Acquisition Cost (WAC) Pricing (PDF, 493 KB) CMS Medicare Claims Processing Manual, Chapter 17, Section 20.1.3
- Note: This applies to drugs that are not reimbursed based on the ASP or NOC pricing files

Claim Submission and Guidelines

Allergy Testing and Immunotherapy (PDF, 1.15 MB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Section 200
Discarded Drugs and Biologicals (PDF, 493 KB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Sections 40 and 100.2.9
General Guidance Regarding Drugs and Biologicals (PDF, 1.42 MB) CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, Section 50-50.6
Mandatory Assignment on Carrier Claims (PDF, 1.63 MB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 1, Section 30.3.1
Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions (PDF, 1.15 MB) Medicare Claims Processing Manual (Pub. 100-04), Chapter 12, Section 30.5)

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