We just listened to a Medicare Lunch and Learn on this topic. This specific scenario was brought up.
They stated that they will pay for wastage from the smallest vial available for purchase. From what you are stating it is possible to administer the exact amount of drug by using 4 4mg vials without wastage therefore it would not be appropriate to report the wastage from a 40mg vial as it is not the smallest vial available.
CMS makes this statement in the Medicare Claims Processing Manual Chapter 17
The CMS encourages physicians, hospitals and other providers and suppliers to care for and administer to patients in such a way that they can use drugs or biologicals most efficiently, in a clinically appropriate manner.Hope this helps!
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