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OIG recommends CMS track Part B claims for compounded drugs

May 1, 2014

The Centers for Medicare & Medicaid Services should establish a method to identify Medicare Part B claims for compounded drugs, the Department of Health and Human Services Office of Inspector General said in report this week. OIG surveyed CMS staff and Part B Medicare Administrative Contractors to assess their oversight of Medicare claims for compounded drugs, citing public health and safety concerns following a 2012 outbreak of fungal meningitis linked to contaminated injectable compounded drugs. CMS concurred with OIG recommendations that the agency establish a method to identify Part B claims for compounded drugs, and that it explore the possibility of conducting descriptive analyses of Part B claims for compounded drugs. CMS did not agree with an OIG recommendation that health care providers identify the compounding pharmacy on the claim, which CMS said would require significant changes to Medicare claims processing systems and would not be a reliable tool for addressing the safety of compounded drugs. Currently, Part B claims for compounded drugs are billed using “not otherwise classified” codes.