April 2019 Quarterly ASP Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

MLN Matters Number: MM11151
Related CR Release Date: January 25, 2019
Related CR Transmittal Number: R4213CP
Related Change Request (CR) Number: 11151
Effective Date: April 1, 2019
Implementation Date: April 1, 2019

The Average Sales Price (ASP) methodology is based on quarterly data submitted to the Centers for Medicare & Medicaid Services (CMS) by manufacturers. CMS supplies the MACs with the ASP and Not Otherwise Classified (NOC) drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the Outpatient Prospective Payment System (OPPS) are incorporated into the Outpatient Code Editor (OCE) through separate instructions available in Chapter 4, Section 50 of the Medicare Claims Processing Manual found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11151.

Last Updated Jan 29, 2019