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Hospital Billing for Take-Home Drugs

This instruction provides instructions for hospitals on billing the appropriate Durable Medical Equipment Regional Carrier (DMERC) for takehome drugs. Program Memorandum (PM) Transmittal A-02-123, dated December 13, 2002 instructed hospitals to bill the appropriate DMERC for immunosuppressive drugs and supplying fees furnished to transplant patients. This Change Request (CR) expands those instructions. Payment for take-home oral anti-cancer drugs, take-home oral antiemetic drugs, and immunosuppressive drugs, as well as the associated supplying fees, shall be billed to the appropriate DMERC. Hospitals shall also bill the DMERC for payment of take-home inhalation drugs and the associated dispensing fees. Immunosuppressive drugs and supplying fees provided by a dialysis facility in the State of Washington are paid by the fiscal intermediary (FI). Chapter 17 of the Medicare Claims Processing Manual is updated to reflect these changes.

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Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 03, 2006

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.