Question:

In the case of Medicare, what is a SCOD?

Answer:

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 defines a specified covered outpatient drug (SCOD) as a covered outpatient drug for which a separate ambulatory payment classification (APC) has been established and that is either a radiopharmaceutical agent, or a drug or biological for which payment was made on a pass-through basis on or before December 31, 2002.  Payment for SCODs is set, by law, at the average acquisition cost.  Under the OPPS, a single payment is made for SCODs that includes payment for both the acquisition cost of the drug and any associated pharmacy overhead or nuclear medicine handling costs.

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