US · guidance
CMS Pub. 100-04, ch. 17, § 70.2
Billing Zero Charges for Drug Line Items Provided at No Cost
According to the Social Security Act (SSA) Section 1861(v)(1)(A), the reasonable cost of any service is
the cost actually incurred, excluding any part of an incurred cost found to be unnecessary in the
efficient delivery of needed health services. If a provider does not purchase a drug, but provides the
administration service, the physician cannot bill Medicare for the drug. However, the administration of
the drug, regardless of the source, is a service that represents an expense to the physician. Therefore,
administration of the drug is payable if the drug would have been covered when purchased by the
physician.
Under such circumstances, to avoid a drug administration code denial, a drug code must be present on
the same or prior claim and $0.00 should be entered for the billed amount of the drug.
History
(Rev. 13255; Issued: 06-06-25 Effective: 07-01-25; Effective: 07-07-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e1c7e127e02acefb7878f36fa5b7323fa4613ddf5f09ab36a6bccaa716eda3b7
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.