Pricing & reimbursement

Medicare Part D drug

Definition

A drug covered under the outpatient prescription benefit and dispensed by a pharmacy.

Part D claims are pharmacy transactions priced on the NDC, with no J-code and no administration code.

Medicare Part B drugA drug covered under the medical benefit because it is administered by a clinician rather than self-administered.Definition NCPDPThe standards body for pharmacy transactions, whose telecommunication standard carries retail pharmacy claims.Definition

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340B program Allowed amount AMP (Average Manufacturer Price)ASP (Average Sales Price)ASP plus 6 percent AWP (Average Wholesale Price)Best price Bundled payment

All 153 terms Coding guide J-code directory