Medicare payment method for Drug / Injections

Injections/Drugs/Biologicals Medicare Part B processes claims for injections based on the type of drug injected. Excluding influenza, pneumococcal, and hepatitis B vaccines, three types of injection claims exist:

* Covered injections provided as the only service to the patient
* Covered injections provided during the course of an E/M service
* Excluded injections provided to the patient

When a covered injection is the only service provided, the physician should bill:

The procedure code for the administration; and The procedure code for the drug (when provided by the physician).

If the injection is administered during the course of a covered E/M service, the physician should bill:

The procedure code for an E/M service; and The procedure code for the drug (when provided by the physician).

Note : If an excluded injection is provided to a patient, both the drug and the administration of the drug are excluded items.

Effective for claims processed on or after February 1, 2001, under section 114 of BIPA of 2000, payment for any drug or biological covered under Medicare Part B may be made only on an assignment related basis. This means the physician or supplier agrees to accept the Medicare fee schedule allowance as payment in full for all covered services. Physicians may collect reimbursement for excluded services, unmet deductible, and coinsurance, from the patient. Additionally, Medicare carriers are required to change the assignment of any nonassigned claim received on or after February 1, 2001. In the event that a nonassigned claim is received that includes services that are subject to mandatory assignment in addition to those that are not, the services subject to mandatory assignment will be separated and processed as if assignment had been accepted.