CMS Pub. 100-04, ch. 17, § 80.2.2

The following chart shows which drugs are billed to the A/B MAC (A) or (B) and which drugs are

billed to the DME MAC.

Per the Balanced Budget Act of 1997, effective for claims with dates of service on or after January 1,

1998, the claims processing jurisdiction rules in Chart 1 apply. Effective July 1, 2006, claims from

institutional (hospital) pharmacies are also billed as shown in this chart.

CHART 1

COMBINATION JURISDICTION

Oral anti-cancer

chemotherapy drug with oral

anti-emetic drug

DME MAC maintains processing responsibility for the

National Drug Code (NDC) oral anti-cancer

chemotherapy drug and the K0415 oral anti-emetic drug

code combinations.

DME MAC processes the NDC oral anti-cancer

chemotherapy drug and Q code oral anti-emetic drug(s)

when provided in the physician’s office.

A/B MAC (A) processes the 3-drug combination anti-emetic (Aprepitant) in the form of a Tri-Pak when

dispensed by a hospital.

A/B MAC (A) processes the initial days’ supply of the 3-drug anti-emetic combination when a hospital dispenses

it and writes a prescription for the second and third days’

supply.

DME MAC processes the second and third days’ supply

of the 3-drug anti-emetic combination.

DME MAC processes the NDC oral anti-cancer

chemotherapy drug and/or Q code oral anti-emetic

drug(s) when supplied by a pharmacy, including a

hospital pharmacy.

Oral anti-cancer

chemotherapy drug with

rectal anti-emetic drug

DME MAC maintains responsibility for processing both

the NDC oral anti-cancer chemotherapy drug and the

K0416 rectal anti-emetic drug.

Oral anti-cancer

chemotherapy drug with

intravenous anti-emetic drug

DME MAC maintains responsibility for processing the

NDC oral anti-cancer chemotherapy drug and the A/B

MAC (B) or A/B MAC (A) for processing the

intravenous anti-emetic J code drug(s).

Intravenous anti-cancer

chemotherapy drug with oral

anti-emetic drug

A/B MAC (B) processes the intravenous J code anti-cancer chemotherapy drug. The oral anti-emetic Q code

drug(s) is processed by the DME MAC when provided in

the physician’s office, hospital, or when provided by a

supplier.

Intravenous anti-cancer

chemotherapy drug with

intravenous anti-emetic drug

A/B MAC (B) processes both intravenous anti-cancer

chemotherapy J code drug and intravenous anti-emetic J

code drug(s).

Providers (HIPAA definition) that bill the DME MAC require a supplier number issued by the National

Supplier Clearinghouse (NSC) in order to submit claims. A/B MACs (A) and (B) should instruct

providers without a supplier number to contact the NSC service center at 1-866-238-9652 to request an

enrollment package for a supplier number. Alternatively, providers may go to the CMS Web site,

http://www.cms.gov/Medicare/Provider-Enrollment-and-

Certification/MedicareProviderSupEnroll/EnrollmentApplications.html and download the Form CMS-

855-S in Adobe Acrobat format. The application can be completed hard copy and submitted to the

NSC.