§414.900. Basis and scope.
42 C.F.R. § 414.900
This subpart implements sections 1842(o), 1847A, and 1847B of the Act and outlines two payment methodologies applicable to drugs and biologicals covered under Medicare Part B that are not paid on a cost or prospective payment system basis.
Examples of drugs that are subject to the requirements specified in this subpart are—
Drugs furnished incident to a physician's service; durable medical equipment (DME) drugs.
Separately billable drugs at independent dialysis facilities not under the ESRD composite rate.
Statutorily covered drugs, for example—
Influenza.
Pneumococcal, Hepatitis B, and COVID-19 vaccines.
Antigens.
Hemophilia blood clotting factor.
Immunosuppressive drugs.
Certain oral anti-cancer drugs.
Notes, amendments, and revision history
Amendments
[69 FR 66424, Nov. 15, 2004, as amended at 70 FR 39093, July 6, 2005; 85 FR 71197, Nov. 6, 2020]
Source
Source: 69 FR 66424, Nov. 15, 2004, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).
Source
Source: 55 FR 23441, June 8, 1990, unless otherwise noted.
Amendments
[69 FR 66424, Nov. 15, 2004, as amended at 70 FR 39093, July 6, 2005; 85 FR 71197, Nov. 6, 2020]