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Drugs and Biologicals

Q. When billing for J3396 – Visudyne™, do we bill for the used and wasted amount of the drug?
A. Per the CMS On-line Manual, Pub. 100-4, Chapter 17, Section 40, CMS encourages physicians to schedule patients in such a way that they can use drugs most efficiently. However, if a physician must discard the remainder of a vial or other package after administering it to a Medicare patient, the program covers the amount of drug discarded along with the amount administered.
Note: The coverage of discarded drugs applies only to single use vials. Multi-use vials are not subject to payment for discarded amounts of drugs.
(Last Modified 9/27/07)
Source: CMS IOM Pub 100-04 – Medicare Claims Processing Manual, Chapter 17, Section 40
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