OBJECTIVES: In the absence of a national Medicare policy for a new technology in the United States, each of 13 regional Medicare Administrative Contractors (MACs) makes independent coverage policies for the program. Our objective was to evaluate geographic variation in regional coverage policies for selected Medicare Part B (non-self-administered) biologics. METHODS: We considered four biologics indicated for rheumatoid arthritis, psoriatic arthritis, psoriasis, Crohn’s disease, and/or ankylosing spondylitis (n=4 biologics across the 13 regional MACs covering 52 possible policies). To identify MAC coverage policies, we used the Centers for Medicare and Medicaid Services’ (CMS’s) Medicare Coverage Database (www.cms.gov/medicare-coverage-database), which details the program’s coverage policies.  For each of the biologics, we determined whether there was a national coverage decision. If not, we established whether each MAC had a formal coverage policy or whether it adjudicated claims for the biologic on a “case-by-case” basis. We further classified MAC coverage policies by whether they contained any coverage restrictions, e.g., limited to “moderately to severely active rheumatoid arthritis” or “inadequate response to one or more TNF antagonist therapies.” RESULTS: As of January 2013, none of the biologics had a national coverage decision. Six of the 13 MACs had issued a total of 16 coverage policies associated with these biologics. The other seven MACs had no formal coverage policies for any of the biologics. Thus, MACs had issued formal coverage policies in 16 of the possible 52 cases; the other 36 scenarios were adjudicated on a case-by-case basis. Nine of the 16 formal coverage policies contained coverage restrictions; the remaining seven did not. CONCLUSIONS: There exists a great deal of variation in local Medicare coverage for Part B biologics. Most decisions by MACs for the biologics considered have been made on a case-by-case basis, which may lead to administrative burden and inconsistent access.