With the new Part B payment model, will the add-on payment change? 


Currently, Medicare Part B pays physicians and hospital outpatient departments the average sales price (ASP) of a drug plus a 6 percent add-on. In its new payment model for drugs, CMS proposed changing the add-on payment to 2.5 percent plus a flat-fee payment of $16.80 per drug per day, which will, it says, cover the cost of any Medicare Part B drug. Updates will be applied at the start of each new year for this amount if warranted.


CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.