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Immunosuppressive Drugs - JA DME

Immunosuppressive Drugs




  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review


Topic Details
  • Suppliers may mail immunosuppressive drugs to beneficiary up to two days prior to anticipated discharge date from an inpatient stay. Delivery must be to a valid place of service and not another facility that does not qualify as beneficiary's home. Supplier must enter date of discharge as date of service on claim
  • Continued need is considered met upon a beneficiary qualifying for immunosuppressive drugs. Ongoing documentation is not required to show continued need for life of transplant
  • When a transplant cannot be located in Medicare's claim database, bill immunosuppressive claims with KX modifier to notify Medicare that documentation is on file that indicates date of transplant, services furnished are medically necessary, and that Medicare paid for transplant in accordance with statue. KX modifier is not required but Medicare will deny claim if claim indicating that transplant was paid for by Medicare Fee-For-Service cannot be identified


Last Updated Fri, 07 Oct 2022 20:06:52 +0000

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