New Claims System Update

Provider Manual
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20 PRESCRIPTION DRUG COVERAGE

20.3 Part B Prescription Drugs

Prescription drugs covered under the Medicare Part B benefits are very limited. These include the following:

  • Injectable medications provided incedental to a physician's service
  • Drugs administered through covered DME, such as a nebulizer or infusion pump in the home
  • Certain oral cancer medications
  • Antiemetic drugs administered within 48 hours of chemotherapy
  • Immunosuppressive drugs prescribed following a Medicare-covered organ transplant
  • Erythropoietin for individuals undergoing chronic renal dialysis
  • Parenteral nutrition for members with a permanent dysfunction of the digestive tract

Other drugs may be covered under Part B in certain limited situations. Many Part B drugs and injectable medications provided incidental to a physician’s service require precertification from IntegraNet. Please call 281-591-5289 for additional information.