How many days of notice must be provided by Medicare Administrative Contractors when they decide that drugs will not be covered?


According to the Medicare Benefit Policy Manuel:

“A/B MACs (A), (B), and (HHH), and DME MACs must provide notice 45 days prior to the date that these drugs will not be covered. During the 45-day time period, A/B MACs (A), (B), and (HHH), and DME MACs will maintain existing medical review and payment procedures. After the 45-day notice, A/B MACs (A), (B), and (HHH), and DME MACs may deny payment for the drugs subject to the notice.”


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.