Medicare Contractors are responsible for making the determination concerning whether a given drug or biological is “usually self-administered”. A Contractor’s determination applies only to the geographic area served by that specific contractor. If the Contractor determines that a given drug is “usually self-administered,” it cannot be covered by Medicare under any circumstance, regardless of whether the drug is administered by a physician or anyone else.
Cahaba GBA’s Self-Administered Drug Exclusion Lists include those drugs that are determined by this contractor to be ‘usually self-administered’ based upon the instructions provided in the Medicare Benefit Policy Manual, Chapter 15, Section 50.2 . The Self Administered Drug Exclusion Lists can be accessed from the table below or from the Medicare Coverage Database (MCD).