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Eligible setting: Provider office (POS 11), outpatient hospital (POS 22), or another outpatient setting where the practice buys and administers the drug Not covered: Patient self-administration at home, and drugs dispensed by a retail pharmacy for home use Medical necessity: Each claim needs an ICD-10-CM diagnosis supporting interferon beta-1a for a relapsing form of multiple sclerosis Incident-to rules: When non-physician staff give the injection, the physician must be present in the suite and the service must belong to the care plan J1826 Medicare reimbursement and fee schedule CMS reimburses J1826 at the Average Sales Price (ASP) plus 6%
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10.1016/j.kint.2020.03.005 18 CheungK
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