MLN Matters Number: MM12244 Revised
Related CR Release Date: June 8, 2021
Related CR Transmittal Number: R10836CP
Related Change Request (CR) Number: 12244
Effective Date: July 1.2021
Implementation Date: July 6,2021

Note: CMS revised this article to reflect a revised CR 12244. The CR revision added language regarding Section 405 of the Consolidated Appropriations Act, 2021. CMS added parts of that language in red font on page 2. CMS also revised the CR release date, transmittal number, and the web address of the CR. All other information is the same.

CR 12244 informs you about the Average Sales Price (ASP) methodology, which is based on quarterly data manufacturers submit to CMS. CMS gives the MACs 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 in the Outpatient Code Editor (OCE) through separate instructions in Chapter 4, Section 50 of the Medicare Claims Processing Manual. Please make sure your billing staffs are aware of these updates.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)12244.