Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 203 - Physician Services
Chapter 2 - Physician-Administered Drugs and Implantable Drug System Devices
Rule 23-203-2.2 - Drug Rebates
Universal Citation: MS Code of Rules 23-203-2.2
Current through September 24, 2024
A. In accordance with federal regulations, the Division of Medicaid collects Medicaid drug rebates from manufacturers on physician-administered drugs per the following:
1. Effective for all drugs administered on
and after January 1, 2008, providers must submit the National Drug Code (NDC)
of the drug administered in addition to the appropriate drug code for
physician-administered drugs on claims.
a) An
NDC is not required for vaccines or other drugs as specified by CMS.
b) The NDC of the drug administered must
contain eleven (11) digits in the five (5) four (4) two (2) grouping and, if
applicable, include "leading zeros (0)" to constitute an eleven (11) digit NDC
code.
c) The NDC of the drug
administered must be matched against a database to ensure its validity.
2. Providers reimbursed
based on a fee-for-service must submit the NDC of the drug administered with
the appropriate code(s) including, but not limited to, ambulances, independent
radiology clinics, free-standing and hospital based dialysis facilities, nurse
practitioners, optometrists, individual physicians, physician groups, physician
assistants, and podiatrists.
3.
Providers reimbursed based on a per diem, encounter or other type of rate are
not required to submit the NDC or appropriate code(s) for drugs
administered/dispensed by providers including, but not limited, to outpatient
hospitals, federally qualified health centers (FQHC), rural health clinics
(RHC), ambulatory surgical centers (ASC), home health agencies, nursing homes
or other long term-term care facilities.
4. The Division of Medicaid only reimburses
for physician administered drugs that are:
a)
Subject to the federal rebate program, and
b) Not considered Drug Efficacy Study
Implementation (DESI) drugs.
5. Providers participating in the 340B
program must adhere to all the provisions in Miss. Admin. Code Part 200,
Chapter 4, Rule 4.10.
B. The Division of Medicaid has the authority to recoup monies when an audit determines that the incorrect NDC number was billed.
Deficit Reduction Act of 2005; 42 U.S.C. § 1396r-8; Miss. Code Ann. § 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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