Self-Administered Drug Exclusion List: (SAD List)

Medicare excludes drugs that are usually self-administered (defined as self-administration by >50% of Medicare beneficiaries) from outpatient drug coverage; oral, topical, inhaled, suppository, and generally subcutaneous drugs are presumed self-administered and excluded absent contrary evidence. Drugs administered IV or IM, or used for acute short-term indications (<2 weeks), are presumed not self-administered and may be covered; contractors will use peer-reviewed literature, practice standards, FDA labeling, and package inserts to make determinations. Drugs on the SAD exclusion list are published with a 45-day notice after which payment is denied, and certain multi-route J/Q codes require JA/JB modifiers (or specific handling for J0801/J0802) or claims will be denied.

"Drugs administered intravenously are presumed not usually self-administered and therefore may be covered absent evidence to the contrary."