Will You Be Reimbursed for High-Priced Drugs?
Medicare won't pay separately if the medication "functions as a supply."
B
efore you buy the high-priced drugs your surgeons like to use
for their cases, make sure your facility will be reimbursed for
them. There are a few questions you'll need to ask — as you'll
see, the answer isn't always apparent.
Does the drug function as a supply? If Medicare decides that a
drug used during surgery "functions as a supply," you won't be
paid separately for it. Under a relatively recent policy, CMS will pack-
age payment for drugs that function as supplies during a surgical pro-
cedure into the facility fee — regardless of the drug's cost.
Does it cost more than $120? This next question is confusing to
some. A 2018 Medicare ruling states it will pay separately (at
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1 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 8
• DRUG PAYMENT Medicare won't pay surgical facilities separately for drugs that "function as supplies."
Coding & Billing
Kara Newbury, JD