CMS Pub. 100-04, ch. 17, § 20.5.4

A/B MACs (B) use ampules, single dose and multiple dose vials and repacks to compare the strength and

dosage. If multiple dose vials are used, A/B MACs (B) must determine how they are used, based on the

strength indicator compared with the HCPCS code description (i.e., if the strength on the vial matches the

HCPCS description, multi-dose vials should be used).

A/B MACs (B) must determine which of the following conditions are true before pricing the drug:

1. The strength and dosage of the drugs in the price source match the HCPCS code and description.

A/B MACs (B) calculate allowable reimbursements for drugs using “all” the NDCs for a given active

drug ingredient and calculate a unit price that is associated with the HCPCS descriptor. If, for example,

the HCPCS code descriptor specifies 50 ml and there is a 50 ml size shown in the Redbook or other

source material, they may use only the 50 ml size (and not use 10-5 ml vials) or may use all products

that meet the strength based on strength and volume of the drug. In the latter case price per unit is

calculated and then converted to the HCPCS units definition.

2. The strength and dosage from the HCPCS code description are not found in the price source.

A/B MACs (B) use the closest dosage to the HCPCS definition without exceeding the dosage.

3. The strength and dosage in the price source do not include a generic form but do include a brand

form.

A/B MACs (B) use the lowest brand price.