Content Section
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January 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective January 1, 2006, and Revisions to January 2005, April 2005, July 2005, and October 2005 Quarterly ASP Medicare Part B Drug Pricing Files
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MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Provider Types Affected
All Medicare providers who bill Medicare for Part B drugs
Provider Action Needed
Impact to You
CR 4140 provides notice of the updated payment allowance limits in the January 2006, January 2005, April 2005, July 2005, and October 2005 drug pricing files.
What You Need to Know
Be aware that certain Medicare Part B drug payment limits have been revised and that the Centers for Medicare & Medicaid Services (CMS) updates the payment allowance quarterly. The revised payment limits included in the revised ASP and Not Otherwise Clarified (NOC) payment files supersede the payment limits for these codes in any publication published prior to this document.
What You Need to Do
Make certain that your billing staffs are aware of these changes.
Background
According to section 303(c) of the Medicare Modernization Act of 2003 (MMA), CMS will update the payment allowances for Medicare Part B drugs on a quarterly basis. Beginning January 1, 2005, Part B drugs (that are not paid on a cost or prospective payment basis) are paid based on 106 percent of the average sales price (ASP).
The ASP is calculated using data submitted to CMS by manufacturers on a quarterly basis and each quarter CMS will update your carrier/FI payment allowance limits with the ASP files. On or after December 19, 2005, revised January 2005, April 2005, July 2005, and October 2005 ASP and NOC payment files, and the January 2006 ASP and NOC files will be available for download.
- The revised January 2005 payment allowance limits apply to dates of service January 1, 2005 through March 31, 2005.
- The revised April 2005 payment allowance limits apply to dates of service April 1, 2005 through June 30, 2005.
- The revised July 2005 payment allowance limits apply to dates of service July 1, 2005 through September 30, 2005.
- The revised October 2005 payment allowance limits apply to dates of service October 1, 2005 through December 31, 2005.
- The January 2006 payment allowance limits apply to dates of service January 1, 2006 through March 31, 2006.
Exceptions
There are, however, exceptions to the general rule, and they were summarized in MM3846, effective July 1, 2005 and may be viewed at http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3783.pdf  on the CMS Web site.
Implementation
The implementation date for this instruction is January 3, 2006.
Additional Information
The official instruction issued to your carrier/intermediary regarding this change may be found at http://www.cms.hhs.gov/Transmittals/ on the CMS Web site.
From that Web page, look for CR 4140 in the CR NUM column on the right and click on the file for that CR. CMS will also update the Microsoft Excel files on the CMS Web site to reflect these revised payment limits. Those files can be found at http://www.cms.hhs.gov/providers/drugs/asp.asp on the CMS Web site.
If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.
Pub. 100-4, Transmittal# 746 , CR# 4140
Medlearn Matters Number: MM4140
Related CR Release Date: November 4, 2005
Effective Date: January 1, 2005
Implementation Date: January 3, 2006
Posted: 11/18/2005
CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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