Codes 777 | ICPhA

Codes 777

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Harry P.
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Last seen: 1 year 3 months ago
Joined: 29/01/2017 - 20:52
Codes 777

Hello all,

Can I ask what's the story with these codes? I have a few questions if anyone could give me a hand:

- How can we know what is reimbursed under these codes or not? Is it only the ones that already have those codes assigned on the MPS?

- How is the claim done? Do I have to change the "GMS code" of the product and the reimbursement price (which is....?) before doing the dispense? And then send the claim electronically as a normal product?

- What price am I reimbursed? The trade price? 

This is so confusing, either a product is reimbursed or not. Why make so many exceptions?!? 

Thanks in advance!

icadmin
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Last seen: 1 week 1 day ago
Joined: 11/01/2017 - 15:54

Thanks for the excellent question Harry.

It's essentially hardship on DPS, but without the individual approval. If you get thumbs up from PCRS, then you submit with 77750 (no VAT) or 77751 (with VAT) and attach an invoice to the claim.

These items will generally not have GMS codes.

Be very careful with this though. Never assume you will get paid. Always check with the PCRS first or you could end up out of pocket. There is no hard and fast rule and rules change without notice.

Anecdotally, even if they confirm, you can still sometimes end up out of pocket.

You will be reimbursed the cost price on the invoice, unless PCRS think it's excessive in which case they may decide to pay you whatever they think is a fair price.

If the patient doesn't go over the DPS threshold, you're better off putting through as Drug Refund and not worry about it.

I hope that helps.