Part B vs Part D
Which Medicare benefit pays for a drug in each setting, and what each lawful pathway pays. Part B and Part D are not a choice: a drug is not a Part D drug when Part A or B would pay for it as prescribed and administered, so the answer depends on the facts of the case.
Examples
- J0490 Belimumab (IV or subcutaneous)
- J3285 Treprostinil (pump)
- J7507 Tacrolimus (transplant)
- J0897 Denosumab
Guidance only, not a coverage determination.
Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.