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April 2016
More tips on correct billing for certain drugs
In the March 2016 Record, we gave you tips on how to calculate national drug code units. The additional NDCs listed in the table below are often billed with the incorrect quantities under the medical drug benefit. To ensure that the payment received is what’s expected, make sure you submit the appropriate quantities on claims for all NDCs.
Make sure you share the following information with your biller or billing company.
| Procedure |
Procedure code billable units** |
NDC code |
NDC billable unit** |
Dose example |
Tip for determining the NDC quantity (units) |
NDC quantity*** (for dose example) |
90633 |
N/A |
00006483141 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90651 |
N/A |
00006411903 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90685 |
0.25 ml |
49281051525 |
ML |
0.25 ml |
Amount administered |
ML0.25 |
90686 |
0.5 ml |
58160090352 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90688 |
0.5 ml |
49281062315 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90698 |
N/A |
49281051005 |
UN |
1 |
Combination vaccine; bill number of vials used (1 dose equals 1 vial). |
UN1 |
90707 |
N/A |
00006468100 |
UN |
1 |
Combination vaccine; bill number of vials used (1 dose equals 1 vial). |
UN1 |
90715 |
0.5 ml |
49281040015 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90716 |
N/A |
00006482700 |
UN |
|
Concentration is 1350 units/vial; bill number of vials used (1 dose equals 1 vial). |
UN1 |
90723 |
N/A |
58160081152 |
ML |
1 |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
J0129 |
10 mg |
00003218710 |
UN |
750 mg |
Concentration is 250 mg/vial, which means for every 250 mg given, 1 vial is used. Bill number of vials used (750 divided by 250). |
UN3 |
J0585 |
1 unit |
00023392102 |
UN |
200 units |
Vial contains 200 units; bill number of vials used. |
UN1 |
J1040 |
80 mg |
00009030602 |
ML |
80 mg |
Concentration is 80 mg/ml, which means for every 80 mg given, 1 ml is administered. |
ML1 |
J1050 |
1 mg |
59762453701 |
ML |
150 mg |
Concentration is 150mg/1ml, which means for every 150 mg given, 1 ml is administered. |
ML1 |
J1050 |
1 mg |
00009062601 |
ML |
400 mg |
Concentration is 400 mg/1 ml, which means for every 400 mg given, 1 ml is administered. |
ML1 |
J3301 |
10 mg |
00003029328 |
ML |
40 mg |
Concentration is 40 mg/ml, which means for every 40 mg given, 1 ml is administered. |
ML1 |
** Billable units can be found on the injections minimum fee schedule on web-DENIS.
*** To be billed in CTP segment for electronic claims (ANSI 837P).
For more quick tips and general guidelines on proper submissions, please reference the February 2015 Record.
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