Injectable physician-administered products are typically covered under the medical or Part B benefit, though some payers may require coverage under the pharmacy or Part D benefit. Coverage details can be determined during the benefits verification process.
The reimbursement rates of injectable physician-administered drugs covered under the medical or Part B benefit may depend on site of care, payer, and drug-specific information.
Regularly review insurance provider payments to the office and reconcile reimbursement of both primary and secondary insurance providers.
For more information on payment rates for injectable drugs in freestanding infusion centers/physician offices and hospital outpatient departments, consult the Billing and Coding Guide.