Medicare Part A billing in a retail pharmacy

[justjoe]

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Does anyone have any information on how to do this? Is the medication just cashed out and charged to the facility and the facility bills Medicare?

 

[zelman]

I can’t think of another way to do it, but that sounds sketchy. I’d probably end up calling Medicare.

 

[lord999]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c03.pdf

You shouldn't be able to do this from a pharmacy as Part A claims has to go with CMS-1450 or its electronic equivalent, which precludes pharmaceuticals from individual billing. Where the facility gets the drug is not CMS's concern (both SNF aka nursing homes and LTAC source from retail pharmacies sometimes), but medications may not be directly billed as part of Part A.

There are a couple of exceptions and they both pertain to blood products, clotting and ESA's. But those have defined HCPCS CPT codes that have to be paired correctly. Again, a pharmacy can't do this as it's not considered a facility.