Self-Administered Drug Exclusion

Medications that are self-administered more than 50% of the time for all Medicare beneficiaries are excluded from Medicare Part B coverage. 

At the direction of CMS, each MAC shall create an article that includes all medications deemed self-administered, and thus excluded from Part B coverage. 

National Government Services has two of these articles, one for each of our jurisdictions:

• JK Article – Self-Administered Drug Exclusion List: Medical Policy Article (A53021) 
• J6 Article – Process for Determining Self-Administered Drug Exclusions – Medical Policy Article (A53020) 

For additional details on classifying a medication as self-administered, please review the CMS Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.2.

Posted 3/26/2024