We also note that, unlike the current coding to describe certain CTBS services, we are proposing that the code descriptors for GPCM1, GPCM2, and GPCM3 would not include the timeframe restrictions for billing certain CTBS (for example, the restriction for virtual check-in services that there is not a related E/M service provided within the previous 7 days or an E/M service or procedure within the next 24 hours or the soonest available appointment)
For drugs covered as additional preventive services, as defined at 410.64 of this subchapter, and for the administration and supplying fees for those drugs, payment to RHCs or FQHCs is 100 percent of the Medicare payment amount per 405.2410(b) and 410.152(l)(11) of this chapter, subject to the payment limitations described at 410.152(o) of this chapter
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Archived from the original on November 6, 2020
(1) Section 1860D-14B(f) of the Act precludes administrative or judicial review on the determination of units as set forth in 428.203, the determination of whether a drug is a Part D rebatable drug as set forth in 428.101, and the calculation of the rebate amount as set forth in 428.201(a) inclusive of any reconciled rebate amount
