37.85.903 PHYSICIAN-ADMINISTERED DRUGS, DEFINITIONS
(1) "340B Drug Pricing Program (340B)" means a federal program administered by the Health Resources and Services Administration (HRSA) which allows qualified entities to purchase pharmaceuticals at a substantially reduced cost under PL 102-585, section 602, of the Veterans Health Care Act of 1992.
(2) "Carve out" means the process by which qualified entities may remove Medicaid clients from 340B program activities and, therefore, purchase pharmaceuticals at a non-340B cost.
(3) "Healthcare Common Procedures Coding System (HCPCS)" means the national uniform coding method maintained by the CMS that incorporates the American Medical Association (AMA) Physicians Current Procedural Terminology (CPT) and the three HCPCS unique coding levels, I, II, and III.
(a) For purposes of physician-administered drugs, HCPCS refers to billable codes with corresponding rebatable National Drug Codes (NDC).
(4) "National Drug Codes (NDC)" means an 11 digit numerical code maintained by the Federal Drug Administration (FDA) under the Drug Listing Act of 1972 that identifies the manufacturer, product, and package size.
(5) "Physician-administered drugs" means drugs other than vaccines covered under section 1927(k)(2) of the Social Security Act that are typically furnished incident to a physician's services.
(a) Physician-administered drugs are administered by a medical professional in a physician's office or other outpatient clinical setting.
(b) Physician-administered drugs are incident to a physician's services that are separately billed to Medicaid.
(c) Reimbursement for physician-administered drugs is allowed only if the drug qualifies for rebate in accordance with 42 USC 1396r-8.
History: 53-2-201, 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 2008 MAR p. 956, Eff. 5/9/08; AMD, 2008 MAR p. 2671, Eff. 12/25/08.