Self-Administered Drug Exclusion List: Medical Policy Article

Medicare does not cover drugs listed on the 'Usually Self-Administered' exclusion list for Part A and Part B; coverage determinations and the definitive excluded-drug lists (with effective dates) are maintained by the MAC contractor for each jurisdiction. Claims for multi-route HCPCS codes require route-specific modifiers (JA for IV, JB for SQ) or they will be denied, and for J0801/J0802 JB must be used for SQ while IM should be billed without a modifier.

"Coverage determinations for self-administered drugs are made by the MAC contractor in each jurisdiction for both Medicare Part A and Part B."

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