Compound Medications Covered by the Georgia Fee Schedule

The Georgia Workers’ Compensation Medical Fee Schedule serves to establish maximum fee amounts and uniform payment guidelines for reimbursement to medical providers for their treatment of injured employees. This is not likely to be a surprise, but did you know that compound medications are also covered by the Fee Schedule?

Compound medications are created at specific compounding pharmacies when a pharmacist combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient. Most often, compound medications are used in topical treatments and give the prescriber more control over the strength and dosage, or to remove a nonessential ingredient, such as gluten or dye, that a patient is allergic to.

In order to be covered by the Fee Schedule, compound medications are to be billed by the compounding pharmacy. They shall be billed by listing each ingredient, the corresponding NDC, and the quantity. An ingredient for which there is no NDC does not require reimbursement. For compound medications, reimbursement shall only be considered for preparations that contain not less than one, nor more than three active ingredients, and the active ingredients must be FDA approved. If the NDC for the compound ingredient is a repackaged drug, the maximum allowable reimbursement for the repackaged drug shall be determined based on the average wholesale price of the NDC of the original manufacturer. Finally, the maximum allowable reimbursement for the compound shall be the sum of the average wholesale price for each active ingredient, minus 50%, plus a single compounding fee of $20.00.

Written by: Ariel I. Adams, Esq.