Self-Administered Drug Exclusion List:

Noridian presumes intravenous and intramuscular outpatient administrations, acute courses under two weeks, certain acute settings (ED, pre‑op, chemotherapy), and infrequent dosing (approximately once/month) are 'not usually self‑administered' and thus meet the Medicare benefit category. Drugs that are self‑administered by >50% of Medicare beneficiaries for a given indication, non‑parenteral routes (oral/topical/suppository), subcutaneous forms on the exclusion list, and all forms of insulin are excluded from Medicare payment; claims for multi‑route drugs require JA/JB modifiers (and specific rules for J0801/J0802) and will be denied if billed without required modifiers. Providers should support determinations with clinical indication, route, claims data, FDA labeling and accepted evidence; Noridian issues a 45‑day notice before denying payment and periodically updates the exclusion list.

"Drugs administered intravenously (IV) are presumed to be 'not usually self‑administered' and meet the Medicare Part A/B benefit category for outpatient administration."