Patient/Manufacturer Supplied Drug identification on claims

Does anyone have CMS guidance regarding the designation of patient provided/supplied drugs on claims: Revenue Code, HCPC Code and Qty?

Comments

  • Hello- We don't allow patient supplied meds, but for white bagged meds, we use the same rev code (usually 0636, same HCPC, same qty), but alternate the charge to $0.10 and move it to the non-covered column of the claim.

    CMS has guidance that makes anything under $1.10 a token charge, but we found they sometimes pay on $1.10, so switched to $0.10.

    Aetna requires a penny, so you may need logic for them too.

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