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August 2, 2021

Claims for Drug Administration Must Include the Drug Administered

We are seeing an increase in requests for Redetermination and Reopening of claims submitted for drug administration. Please remember the following to avoid the need to request appeals and adjustments so that your claims process correctly upon initial submission:

  • Claims for drug administration MUST include a separate line item for the actual drug administered.
  • Do not submit drugs/services with a zero charge.
    • If/when a drug you administer is of no cost to you, add the drug code to your claim with a 1¢ charge.
    • If/when your patient brings in a covered drug for you to administer, add the drug code to your claim with a 1¢ charge.
  • If you receive a rejection (i.e., MA130) due to a claim submission error, please correct the error that caused the rejection and resubmit as a new claim. Rejections have no appeal rights; nor do they qualify for adjustment.

For additional information please refer to Drug Administration Reminder (cgsmedicare.com).

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