Drugs and Biologicals
Published 01/01/2020
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)