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Exceptions to Average Sales Price (ASP) Payment Methodology – Claims Processing Manual Changes

The purpose of this Change Request (CR) is to update language in the Claims Processing Manual (100-04) Chapter 17 Section 20.1.3 - Exceptions to Average Sales Price (ASP) Payment Methodology and also to include updates to section 20.3. The updates pertain to Wholesale Acquisition Cost (WAC)-based contractor pricing, and payment for infusion drugs furnished through a covered item of durable medical equipment.

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 25, 2022

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.