Self-Administered Drug Exclusion List:

Medicare Part B excludes drugs that are usually self‑administered (oral, topical, suppository, and subcutaneous when >50% of beneficiaries self‑administer) while generally covering injectable drugs (IV/IM) that are not usually self‑administered and meet medical necessity/FDA/incident‑to criteria. Contractors must apply a structured evidentiary process (including utilization %, literature, FDA labeling and claims data), require JA/JB modifiers for multi‑route HCPCS codes, and provide a 45‑day notice plus appeal rights before removing coverage for a previously covered drug.

"Medicare covers drugs and biologicals that are not usually self‑administered (i."

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