Results 1 to 3 of 3

Off Label use of Drug and billing patient

  1. #1
    Unhappy Off Label use of Drug and billing patient
    Medical Coding Books
    I would appreciate anyones help who can direct me to the page on Medicare's website that states something like this. When a drug is used for a non approved off lablel diagnosis, we will not pay for the DRUG OR ADMINISTRATION of the drug.

    I had this before and this question is rearing its ugly little head again and I can not find the information to prove my point.

  2. #2
    Check the OIG website, they just slammed Pfizer for this.

    Laura, CPC, CEMC

  3. #3
    Excerpts from CMS internet only Manual (IOM):
    Publications 100-02 Medicare Benefit Policy Manual: Chapter 15 Section 50.4.5 - Unlabeled Use for
    Anti-Cancer Drugs
    If a use is identified as not indicated by CMS or the FDA or if a use is specifically identified as not
    indicated (in one or more of the three compendia mentioned) or if it is determined (based on peer
    reviewed medical literature) that a particular use of a drug is not safe and effective, the off-label usage is
    not supported and, therefore, the drug is not covered. In this instance, the administration is also not

    However, keep in mind that reviewed medical literature can sometime overturn the compedia. Thanks, Angela

Similar Threads

  1. Billing for drug testing of a patient.
    By in forum Billing/Reimbursement
    Replies: 0
    Last Post: 08-01-2012, 08:17 PM
  2. Patient refuses Chemo drug
    By nlaaron in forum Hematology/Oncology
    Replies: 2
    Last Post: 02-24-2012, 04:10 PM
  3. Help when a patient reacts to a chemo drug
    By myando in forum Hematology/Oncology
    Replies: 4
    Last Post: 02-24-2012, 09:38 AM
  4. J2353 Off label chemo drug special consideration
    By MChappell159 in forum Hematology/Oncology
    Replies: 1
    Last Post: 05-10-2011, 01:21 PM

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.