Pharmacy Question for the Week of September 16, 2019

Question:

What are some examples of when medications would not be reasonable and necessary according to accepted standards of medical practice?

Answer:

According to the Medicare Benefit Policy Manual, the following three criteria define when a medication is considered not reasonable:

Medications are given that are not for a particular illness
When the injection method is not indicated
Medications that exceed the frequency or duration of accepted standards of medical practices.

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.

Pharmacy Question for the Week of September 16, 2019

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