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Thread: The price we pay for injectables VS ASP!!

  1. #1
    Join Date
    Apr 2007
    Johnson City

    Default The price we pay for injectables VS ASP!!

    AAPC: Back to School
    Could any of you explain this to me?

    We spend at least 3-4 times more on injectables when we order our supplies, than what we are being reimbursed by carriers who's fees are based on Average Sales Price, (ASP).

    For example code J0696 Rocephin 250mg costs us $17.50 from supplier. Insurance carrier pays based on ASP and allows payment of .95

    Does this mean we are getting ripped off by the supplier and should shop around for a better price? Is Average Sales Price, what it costs the manufacturer, then it's marked up when sold by the suppliers???? Or is this just the way it is and providers are expected to just take a loss on injectables? I'm I missing something here?

    Thanks in Advance,
    Melissa Jewett, CPC

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    We charge $28.00 to non-government insurance; most reimburse at about $22, which is the National Average Payment according to Encoder Pro. However, Medicare and Medicaid only allow between $1.04 and $1.15 here in SD.

    Is the 0.95 you're receiving from Medicare or Medicaid? If so, that's probably correct for your area. If it's an insurance you are par with, I would look at the contract to see what they are obligated to pay for injections - most of ours have language about the National Average Payment for injectibles.

    And, I would check with suppliers. I could be wrong, but $17.50 for 250 mg of Rocephin seems awfully high.

    Hope this helps.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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