US · guidance
CMS Pub. 100-04, ch. 17, § 20.5.3
Use of Generics
A/B MACs (B) identify the generic name of the drug from the code description. They always rely on the
CMS HCPCS tape file or an official HCPCS publication.
A/B MACs (B) locate generic sources in the Drug Topics Redbook or other source based on the HCPCS
description of the drug. They use entries that match the strength of the drug described by the HCPCS
code, e.g., 50 mg, 100 mg, etc.
To determine if a drug is generic or brand, A/B MACs (B) compare the name of the drug in the HCPCS
code (generic) with the name of the drug being identified. If they are the same, the drug is generic. If they
are different, the drug is a brand. For example, the description for J3360 is injection, diazepam, up to 5
mg. Diazepam is the generic name. The HCPCS code for Valium is listed as J3360. Valium is a brand
name.
If there is a question as to whether a drug is brand or generic, A/B MACs (B) consult the PDR Generics,
or telephone the drug company.
History
(Rev. 397, Issued: 12-16-04, Effective: 01-01-05, Implementation: 01-03-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a18f360cfacf524b4faeefd146cc18758a42a46e6b58d6f7462bf1c3f29f80f8
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