Question:
What does the term “by the patient” mean?
Answer:
The term “by the patient” means Medicare beneficiaries as a collective whole. The A/B MAC (B) includes only the patients themselves and not other individuals, which CMS defines as spouses, friends, or other caregivers. The determination is based on whether the drug is self-administered by the patient a majority of the time and whether it is used on an outpatient basis by Medicare beneficiaries for medically necessary indications. The A/B MAC (B) ignores all instances when the drug is administered on an inpatient basis.
CPT® copyright 2024 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.
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