(1) Drugs, Medications, Supplies, and Laboratory Specimen Collections. (a) Payment rates for drugs, vaccines, and immune globulins administered in a physician’s office are equal to the fee listed in the Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File. For drugs, vaccines, and immune globulins administered in a physician’s office that are not listed in the Quarterly ASP Medicare Part B Drug Pricing File, codes are listed in 101 CMR 317.04(4) with payment set by I.C., which will apply y until such time as the code is listed in the Quarterly ASP Medicare Part B Drug Pricing File.
(d) Payment for drugs and/or biologicals may be claimed in addition to an office visit. Drugs that are considered routine and integral to the delivery of a physician’s professional services in the course of diagnosis or treatment are not reimbursable. Such drugs are commonly provided without charge or are included in the physician’s fee for the service. Drugs and/or biologicals available free of charge from the Massachusetts Department of Public Health are not payable items. When an immunization or injection is the primary purpose of an office or other outpatient visit, the provider may bill only for the injectable material and its administration. Payment for both vaccine administration and an office visit is allowable only when the vaccine administration is a medically necessary, separately identifiable service.
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(1) Drugs, Medications, Supplies, and Laboratory Specimen Collections. (a) Payment rates for drugs, vaccines, and immune globulins administered in a physician’s office are equal to the fee listed in the Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File. For drugs, vaccines, and immune globulins administered in a physician’s office that are not listed in the Quarterly ASP Medicare Part B Drug Pricing File, codes are listed in 101 CMR 317.04(4) with payment set by I.C., which will apply y until such time as the code is listed in the Quarterly ASP Medicare Part B Drug Pricing File.
(d) Payment for drugs and/or biologicals may be claimed in addition to an office visit. Drugs that are considered routine and integral to the delivery of a physician’s professional services in the course of diagnosis or treatment are not reimbursable. Such drugs are commonly provided without charge or are included in the physician’s fee for the service. Drugs and/or biologicals available free of charge from the Massachusetts Department of Public Health are not payable items. When an immunization or injection is the primary purpose of an office or other outpatient visit, the provider may bill only for the injectable material and its administration. Payment for both vaccine administration and an office visit is allowable only when the vaccine administration is a medically necessary, separately identifiable service.