Compliance Question of the Week – Pharmacy

Will Medicare cover IVIG provided in a Medicare beneficiary’s home?

According to the American Medical Association (AMA), the following code took effect on January 1, 2017: 90682—influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use. However, our MAC has denied claims for this code. Does Medicare not accept this new code?

How does CMS determine payment for a drug that is not listed in the ASP file?

Can hospitals bill for a new drug approved by the FDA but with no code assigned yet by CMS?

Is modifier JW always required when a single-use vial drug is discarded?

I thought it was Medicare payers that decided whether modifier JW was required on claims but ours says it is not responsible for this decision. Can you provide information on this?

Does Medicare cover the IVIG drug Bivigam?

Does Medicare cover the IVIG drug Bivigam?

Have the codes to report presumptive drug tests changed this year?

Does Medicare separately pay for drugs used during procedures?

What biosimilars have been approved by the FDA, and how are they coded?

If several pharmacies, each with their own national provider identifier (NPI), are owned by the same covered organization health care provider (payee), may the X12 835 payment and remittance advice for these pharmacies be consolidated and sent to the covered organization health care provider (i.e., the “parent”)?