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April 2022
Outpatient facilities must bill self-administered medications through Medicare Part DIf Medicare Advantage members don’t bring their self-administered medications with them when receiving services at an outpatient facility, the facility should obtain the medications through its onsite ambulatory pharmacy, if one is available. Facilities that obtain these medications through an onsite ambulatory pharmacy must bill them under the member’s Medicare Part D pharmacy benefits. The member is responsible for the copayment amount. When outpatient facilities bill these medications through the member’s Medicare Part B medical benefits, the claims will be denied as not payable. To avoid these problems and help ensure that your claims are processed efficiently and correctly, bill these medications under members’ Medicare Part D pharmacy benefits. This directive applies to Medicare Plus Blue℠ and BCN Advantage℠ members. |
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