MedRx™ and COVID-19 Medical Claims

MedRx™ and New Day-Supply Limits

Current Medicare rules for immunosuppressive drugs used after an organ transplant, oral anticancer drugs, and intravenous immune globulin (IVIG) utilization requirements generally limit dispensing of drug amounts to a 30-day supply. Due to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) now allows Medicare beneficiaries to obtain amounts of Part B drugs in excess of the current monthly (30-day) limitation. This change is effective for claims with dates of service on or after March 1, 2020¹.

Change Healthcare has adjusted the MedRx day-supply edits to accommodate the adjusted supply limitations for those drugs indicated in the above publication. 

In order to allow claims for these items to process more than a 30-day supply for the Medicare Part B drug categories referenced by the DME MACs, the following needs to be provided:

• The ‘CR’ Modifier needs to be submitted in the Procedure Modifier Code field: 459-ER.
• The COVID-19 Narrative must be provided following your normal process for submitting narratives. If entering the narrative on your own using the MedRx Secure website, check to see if a narrative already exists, and then add the prefix “COVID-19,” to the beginning of any existing narrative, rather than replacing the narrative on file.

Resources:

1. (Joint DME MAC Article) Billing of Part B Drugs to DME MACs During COVID-19 Pandemic – Dispensing Amounts