Question:
If a drug is not listed in the Medicare ASP or NOC file, does that mean it’s not covered?
Answer:
For drugs or biologicals not listed in the average sales price (ASP) or not otherwise classified (NOC) drug-pricing files, Medicare administrative contractors (MACs) determine the payment allowance limits in accordance with the policy described in Chapter 17, Section 20.1.3, of the Medicare Claims Processing Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf. The discussion about ASP or NOC files starts in the fourth paragraph.
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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