Access guidance for submitting drugs & biologicals through the following links.

Reimbursement

• Average Sales Price (ASP) and Not Otherwise Classified (NOC) Pricing Files
• Wholesale Acquisition Cost (WAC) Pricing: (PDF, 484 KB) CMS Medicare Claims Processing Manual, Chapter 17, Section 20.1.3
  • Note: This applies to drugs that are not reimbursed based on the ASP or NOC pricing files

Claim Submission and Guidelines

• Allergy Testing and Immunotherapy: (PDF, 902 KB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Section 200 
• Discarded Drugs and Biologicals: (PDF, 484 KB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 17, Sections 40 and 100.2.9
• General Guidance Regarding Drugs and Biologicals: (PDF, 2.11 MB) CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, Section 50-50.6
• Mandatory Assignment on Carrier Claims: (PDF, 1.59 MB) CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 1, Section 30.3.1