Self-Administered Drug Exclusion List:

Medicare excludes drugs that are usually self-administered by patients (defined as self-administered by >50% of Medicare beneficiaries); coverage is limited to drugs furnished incident to a physician's service that are FDA-approved and medically necessary and not usually self-administered. Route of administration, condition status, and frequency guide determinations: IV (and generally IM) drugs and drugs for acute conditions or given <1/week are presumed not self-administered (covered), while oral and subcutaneous drugs are typically excluded; HCPCS multi-route codes require JA/JB modifiers and drugs on the Self-Administered Drug list are denied.

"Medicare covers outpatient drugs furnished 'incident to' a physician's service when the drug is medically reasonable and necessary, FDA-approved, and not usually self-administered by patients."

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