42 C.F.R. § 447.520

Current through October 31, 2024
Section 447.520 - [Effective until 11/19/2024] Federal Financial Participation (FFP): Conditions relating to physician-administered drugs
(a) No FFP is available for physician-administered drugs for which a State has not required the submission of claims using codes that identify the drugs sufficiently for the State to bill a manufacturer for rebates.
(1) As of January 1, 2006, a State must require providers to submit claims for single source, physician-administered drugs using Healthcare Common Procedure Coding System codes or NDC numbers to secure rebates.
(2) As of January 1, 2007, a State must require providers to submit claims for physician-administered single source drugs and the 20 multiple source drugs identified by the Secretary using NDC numbers.
(b) As of January 1, 2008, a State must require providers to submit claims for the 20 multiple source physician-administered drugs identified by the Secretary as having the highest dollar value under the Medicaid Program using NDC numbers to secure rebates.
(c) A State that requires additional time to comply with the requirements of this section may apply to the Secretary for an extension.

42 C.F.R. §447.520

81 FR 5347 , 2/1/2016