Question:

How does Medicare determine payment for a code that isn’t in either the ASP or NOC drug-pricing files?

Answer:

When codes aren’t listed in these files, Medicare Administrative Contractors (MACs) will determine the payment allowance limits in accordance with the policy described in the Medicare Claims Processing Manual, Chapter 17, Section 20.1.3 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf.

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