ACT Questions and Answers - November 14, 2018 - Correction to A20

This article is being published to correct A20 from the November 14, 2018 ACT Questions and Answers article. Share this update with your billing and coding staff.

Q20. Is HCPCS J3030 (injection; Sumatriptan Succinate, 6 mg administered in physician's office) reimbursable as "incident-to" and does not fall under the self-administered drug (SAD) exclusion?
A20. No. To meet all the general requirements for coverage under the incident-to provision, an FDA approved drug or biological must be of a form that is not usually self-administered. See the Self-Administered Drugs (SADs)webpageand the CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.2 - Determining Self-Administration of Drug or Biological.

Last Updated Aug 13, 2019