|
May 2016
More tips on billing correctly for certain medical drugs
During the previous two issues of The Record, we’ve offered tips on how to calculate national drug code units. We’re offering some additional tips this month.
The national drug codes listed in the table below are often billed with the incorrect quantities under the medical drug benefit. To help ensure that the payment you receive is what you’re expecting, submit the appropriate quantities for all NDCs. See the far right column in the chart below for the appropriate NDC quantity for the following drugs.
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 |
00006409502 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90633 |
N/A |
00006483101 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90633 |
N/A |
58160082511 |
ML |
0.5 ml |
Amount Administered |
ML0.5 |
*90633 |
N/A |
58160082552 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90651 |
N/A |
00006412102 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90670 |
.5ml |
00005197101 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90696 |
N/A |
58160081252 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90700 |
N/A |
49281028610 |
ML |
0.5 ml |
Amount administered |
M 0.5 |
*90700 |
N/A |
58160081052 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90710 |
N/A |
00006499900 |
UN |
1 vial |
Combination vaccine; 1 dose equals 1 vial |
UN1 |
*90713 |
N/A |
49281086010 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90715 |
.5ml |
49281040010 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5ml |
ML0.5 |
*90715 |
.5ml |
58160084211 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
*90715 |
.5ml |
58160084252 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5ml |
ML0.5 |
*90744 |
1 Dose |
00006498100 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
J0598 |
10 Units |
42227008105 |
UN |
1000 units |
500 units per vial
(1000/500=2 vials) |
UN2 |
J0717 |
1mg |
50474070062 |
UN |
400 mg |
Concentration is 400 mg per vial |
UN1 |
J3380 |
1mg |
64764030020 |
UN |
300 mg |
Concentration is 300 mg per vial |
UN1 |
J7298 |
N/A |
50419042301 |
UN |
1 IUD |
This is an IUD |
UN1 |
**Billable units can be found on the injections minimum fee schedule on web-DENIS.
*** For billing purposes, these quantities should be entered into the CTP segment for electronic claims (ANSI 837P).
See the April 2016 Record for tips on submitting electronic claims. For tips on submitting paper claims, see the February 2015 Record.
Note: We highly recommend billing electronically for faster claims processing.
| 