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Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Will You Be Reimbursed for High-Priced Drugs? Medicare won't pay separately if the medication "functions as a supply." B efore you buy the high-priced drugs your surgeons like to use for their cases, make sure your facility will be reimbursed for them. There are a few questions you'll need to ask — as you'll see, the answer isn't always apparent. Does the drug function as a supply? If Medicare decides that a drug used during surgery "functions as a supply," you won't be paid separately for it. Under a relatively recent policy, CMS will pack- age payment for drugs that function as supplies during a surgical pro- cedure into the facility fee — regardless of the drug's cost. Does it cost more than $120? This next question is confusing to some. A 2018 Medicare ruling states it will pay separately (at 1 2 1 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 8 • DRUG PAYMENT Medicare won't pay surgical facilities separately for drugs that "function as supplies." Coding & Billing Kara Newbury, JD

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