CMS Policy Change Requires Physicians to Bill Medicare for Medications in Certain Situations

August 11, 2011 11:30 AM

Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 7397 (PDF), which clarifies policy with respect to restrictions on pharmacy billing for drugs provided “incident to” a physician service and rescinds and fully replaces CR 7109. Under the new policy, “pharmacies suppliers and providers may not bill Medicare Part B for drugs dispensed directly to a beneficiary for administration ‘incident to’ a physician service, such as refilling an implanted drug pump.” In addition, “Pharmacies may not bill Medicare Part B for drugs furnished to a physician for administration to a Medicare beneficiary. When these drugs are administered in the physician’s office to a beneficiary, the only way these drugs can be billed to Medicare is if the physician purchases the drugs from the pharmacy.” Opponents of the change have noted that the new policy conflicts with certain DEA regulations and may limit patient access to pain management medications. Additional information is available in a Drug Topics article.