- Coding & Pricing
Medicare Reimbursement Rate
Centers for Medicare & Medicaid Services (CMS) has updated the reported Medicare reimbursement rate for FRAGMIN® (dalteparin sodium injection) - J1645 - Effective April 1, 2012.
2nd Quarter 2012 FRAGMIN® Medicare reimbursement in the Physician
Office setting is $11.033 per 2500 IU1, and FRAGMIN® is
not separately reimbursed in the Hospital Outpatient setting.2
These payment rates and rules are in effect from April 1, 2012 through June 30, 2012.1
Medicare payment for most drugs administered in the physician office setting is now based on the drug's Average Sales Price (ASP) + 6%.1
Medicare does not separately reimburse drugs used in the hospital outpatient setting that are designated as packaged into the outpatient procedure.2
ASP rates are recalculated and released on a quarterly basis by CMS but can be updated more frequently. Please visit the CMS website below for the most up to date information.
For additional information and assistance with FRAGMIN® contact your health plan.
Medicare Reimbursement Rate – Physician Office
References
1. Centers for Medicare & Medicaid Services Web Site, Medicare, Medicare Part B Drugs Average Sales Price, 2012 ASP Drug Pricing Files, April 2012 ASP Pricing File – Updated March 15, 2012. Accessed on March 19, 2012 at this address: http://www.cms.gov/McrPartBDrugAvgSalesPrice/01a17_2012ASPFiles.asp#TopOfPage. Rates are subject to change.
2. Centers for Medicare & Medicaid Services, Medicare Claims Processing Manual, 100-04, Chapter 17, Section 10 – Payment Rules for Drugs and Biologicals
