42 C.F.R. § 414.900

Current through October 31, 2024
Section 414.900 - Basis and scope
(a) This subpart implements sections 1842(o), 1847A, and 1847B of the Act and outlines two payment methodologies applicable to drugs and biologicals covered under Medicare Part B that are not paid on a cost or prospective payment system basis.
(b) Examples of drugs that are subject to the requirements specified in this subpart are:
(1) Drugs furnished incident to a physician's service; durable medical equipment (DME) drugs.
(2) Separately billable drugs at independent dialysis facilities not under the ESRD composite rate.
(3) Statutorily covered drugs, for example-
(i) Influenza.
(ii) Pneumococcal, Hepatitis B, and COVID-19 vaccines.
(iii) Antigens.
(iv) Hemophilia blood clotting factor.
(v) Immunosuppressive drugs.
(vi) Certain oral anti-cancer drugs.

42 C.F.R. §414.900

69 FR 66424 , Nov. 15, 2004, as amended at 70 FR 39093 , July 6, 2005; 85 FR 71197 , Nov. 6, 2020
85 FR 71197, 11/6/2020