100-04 Medicare Claims Processing Manual: Chapter 17 Crosswalk

Medicare Claims Processing Manual
Chapter 17 - Drugs and Biologicals
Crosswalk
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17 	10 	B3-2049,
B3-5201
A-00-36, B-01-10,
B-01-38, AB-01-16,
A-02-129, AB-02-174,
AB-03-014
Payment Rules for Drugs and Biologicals
17 	20 	B3-5202,
R1799B3
AB-02-075,
PRM 2711.2 B. 2 Payment Allowance Limit for Drugs and Biologicals
17 	20.1 	AB-02-075, B-03-059,
AB-03-047,
PRM 2711.2 B. 2
Single Drug Pricer (SDP)
17 	20.2 	B3-5202.1 	AB-02-075,
PRM 2711.2 B. 2 Calculation of the AWP
17 	20.3 	B3-5202.1 	AB-02-075,
PRM 2711.2 B.2 Detailed Procedures for Determining AWPs and the
Drug Payment Allowance Limits
17 	20.3.1 	Background
17 	20.3.2 	AB-02-075,
PRM 2711.2 B. 2 Review of Sources for Medicare Covered Drugs and
Biologicals
17 	20.3.3 	AB-02-075,
PRM 2711.2 B. 2 Use of Generics

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17 	20.3.4 	AB-02-075,
PRM 2711.2 B. 2 Find the Strength and Dosage
17 	20.3.5 	AB-02-075,
PRM 2711.2 B. 2 Restrictions
17 	20.3.6 	AB-02-075,
PRM 2711.2 B. 2 Inherent Reasonableness for Drugs and Biologicals
17 	20.3.7 	B3-5202.2 	Injection Services
17 	20.3.8 	B3-5202.3 	Injections Furnished to ESRD Beneficiaries
17 	30 	B3-5202.1 	AB-02-075,
PRM 2711.2 B. 2 Carrier Distribution of Limit Amounts
17 	40 	AB-02-075,
PRM 2711.2 B. 2 Discarded Drugs and Biologicals
17 	50 	B3-5247 	PM B-01-15 	Assignment Required for Drugs and Biologicals
17 	60 	PM B-01-02 	DMEPOS Suppliers Require a License to Dispense
Drugs
17 	60.1 	B3-4118 	Prescription Drugs Billed by Suppliers Not Licensed to
Dispense Them
17 	70 	Staff developed-No Xref 	Claims Processing Requirements - General
17 	70.1 	B-03-041 	Billing Drugs Electronically - NCPDP
17 	70.1.1 	B-03-057 	Reporting Modifiers in the Compound Drug Segment
17 	70.1.2 	B-03-057 	Coordination of Benefits (COB)

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17 	70.1.3 	B-03-057 	Inbound NCPDP Claim
17 	80 	Title+Xref-Not in manual 	Claims Processing for Special Drug Categories
17 	80.1 	A3-3660.13 	SNF 536.1 	Oral Cancer Drugs
17 	80.1.1 	A3-3660.13 	SNF 536.1 	HCPCS Service Coding for Oral Cancer Drugs
17 	80.1.2 	A3-3660.13 	SNF 536.1 	HCPCS and NDC Reporting for Prodrugs
17 	80.1.3 	A3-3660.13 	SNF 536.1 	Other Claims Processing Issues for Oral Cancer Drug
17 	80.1.4 	A3-3660.13 	SNF 536.1 	MSN/ANSI X12N Message Codes for Oral Cancer
Drug Denials
17 	80.2 	A3-3660.15 	B3-4460 	PM A-98-5 	Oral Anti-Emetic Drugs Used as Full Replacement for
Intravenous Anti-Emetic Drugs as Part of a Cancer
Chemotherapeutic Regimen
17 	80.2.1 	A3-3660.15 	B3-4460 	PM A-98-5 	HCPCS Codes for Oral Anti-Emetic Drugs
17 	80.2.2 	A3-3660.15 	B3-4460 	PM A-98-5 	Claims Processing Jurisdiction for Oral Anti-Emetic
Drugs
17 	80.2.3 	A3-3660.15 	B3-4460 	PM A-98-5 	MSN /ANSI X12N Denial Messages for Anti-Emetic
Drugs
17 	80.3 	B3-4471 	PM AB-01-10 	Billing for Immunosuppressive Drugs
17 	80.3.1 	A3-3660.8 	Requirements for Billing FI for Immunosuppressive
Drugs

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17 	80.3.2 	MSN/Remittance Messages for Immunosuppressive
Drugs
17 	80.4 	B3-5245 	PM AB-00-117,
AB-03-014 Billing for Hemophilia Clotting Factors
17 	80.5 	A3-3660.11,
A3-3660.12
SNF 536.1 	PM AB-02-72 	Self-Administered Drugs
17 	90 	Title-No Xref 	Claims Processing Rules for Hospital Outpatient
Billing and Payment
17 	90.1 	PM-A-00-42,
A-00-61, A-01-50 Blood/Blood Products and Drugs Classified in
Separate APCs for Hospital Outpatients
17 	90.2 	A-02-026 	Changes to Pass-Through Drugs and Biologicals Final
Rule
17 	90.2.1 	PM A-02-026, §IX.A 	HCPCS Codes Replacements
17 	90.2.2 	PM-A-02-026 §IX.B 	Codes Not Recognized for Medicare Under the
Hospital OPPS
17 	90.2.3 	PM-A-02-026 §IX.C 	Additional Drugs Eligible for Pass-Through Payments
17 	90.2.4 	PM-A-02-026 §IX.D 	Changes to Payment Rates and Co-Pay From the
March 1, 2002 OPPS Final Rule
17 	90.2.5 	PM-A-02-026 §IX.E 	Additional Corrections
17 	90.2.6 	PM-A-02-026 §IX.F 	Additional Billing and Reporting Information Related
to Pass-Through Drugs Effective April 1, 200

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17 	90.2.7 	PM-A-02-026 §IX.G 	Typographical Errors from the March 1, 2002, OPPS
Final Rule
17 	90.2.8 	PM-A-02-026 §IX.H 	Correction to 2003 HCPCS Code Books
17 	90.2.9 	PM-A-02-026 §X 	Pro-Rata Reduction in Drug and Device Pass-Through
Payments