Compliance Question of the Week – Pharmacy

Where can I find the list of the drugs and biologicals with new pass-through status for the last quarter of 2018?

Have the new rates for flu vaccines been issued yet?

When does Medicare cover self-administered drugs?

Will Medicare issue payment when the main reason for a patient’s visit is to receive an injection?

The FDA recently approved a biosimilar called Fulphila. Is there a HCPCS code yet for it?

For medications used from Canada that have only a DIN and not an NDC, are you aware if there is a generic NDC that can be used or if CMS and other payers ever recognize the DIN on claims?

If a drug is not listed in the Medicare ASP or NOC file, does that mean it’s not covered?

We have a Coumadin clinic at our facility. The patients are seen by a Coumadin nurse who does a full assessment on the patient she sees every month. During the assessment she also does a PT/INR check on the patient. Is it appropriate to bill the evaluation and management (E & M) level G0463 and the PT/INR check 85610. We have been struggling with this issue for a while and would like some clarifications as soon as possible.

I heard that Medicare may increase the drug payment amount for next year. Is this true?

Where can I find the drugs with corrected Medicare payment rates, and can I resubmit claims to ensure we are paying the correct rate?

What OPPS billing guidelines should be followed when commercially available products are mixed together to facilitate their concurrent administration?

Can you confirm that CMS has deleted code C9469?