Regulations last checked for updates: Oct 17, 2024

Title 42 - Public Health last revised: Oct 15, 2024
§ 447.520 - Federal Financial Participation (FFP): Conditions relating to physician-administered drugs.
Link to an amendment published at 89 FR 79084, Sept. 26, 2024.

(a) No FFP is available for physician-administered drugs for which a State has not required the submission of claims using codes that identify the drugs sufficiently for the State to bill a manufacturer for rebates.

(1) As of January 1, 2006, a State must require providers to submit claims for single source, physician-administered drugs using Healthcare Common Procedure Coding System codes or NDC numbers to secure rebates.

(2) As of January 1, 2007, a State must require providers to submit claims for physician-administered single source drugs and the 20 multiple source drugs identified by the Secretary using NDC numbers.

(b) As of January 1, 2008, a State must require providers to submit claims for the 20 multiple source physician-administered drugs identified by the Secretary as having the highest dollar value under the Medicaid Program using NDC numbers to secure rebates.

(c) A State that requires additional time to comply with the requirements of this section may apply to the Secretary for an extension.

authority: 42 U.S.C. 1302,and,and. L. 111-148
source: 43 FR 45253, Sept. 29, 1978, unless otherwise noted.
cite as: 42 CFR 447.520