|
June 2016
Here are more tips on correct billing for medical drugs
This is number four in a series of Record articles on how to properly calculate national drug code units.
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 accurate, 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) |
90620 |
0.5 ml |
46028011401 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90649 |
N/A |
00006404500 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90696 |
N/A |
58160081211 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90700 |
N/A |
58160081011 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90710 |
N/A |
00006417100 |
UN |
1 vial |
Combination vaccine; 1 dose equals 1 vial. |
UN1 |
90715 |
0.5 ml |
49281040058 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90715 |
1 dose |
49281040088 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90732 |
0.5 ml |
00006473900 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90732 |
0.5 ml |
00006494300 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90734 |
N/A |
49281058958 |
Determine by product used: If it’s a powder that needs to be reconstituted or oral tablet, use UN. If it’s liquid in a vial, use ML. |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
00006409302 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
58160082011 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
58160082052 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
J0897 |
1 mg |
55513073001 |
ML |
120 mg |
Concentration is 120 mg/1.7 ml, which means for every 120 mg given, 1.7 ml is administered. |
ML1.7 |
J2353 |
1 mg |
00078064781 |
UN |
40 mg |
Vial contains 20 mg, which means when 40 mg are given, 2 vials are administered. |
UN2 |
J2357 |
5 mg |
50242004062 |
UN |
300 mg |
Vial contains 150 mg, which means when 300 mg are given, 2 vials are administered. |
UN2 |
J2778 |
0.1 mg |
50242008001 |
ML |
0.5 mg |
Concentration is 0.5 mg/0.05 ml, which means for every 0.5 mg given, 0.05 ml is administered. |
ML0.05 |
J3357 |
1 mg |
57894006103 |
ML |
90 mg |
Concentration is 90 mg/ ml, which means for every 90 mg given, 1 ml is administered. |
ML1 |
J7298 |
N/A |
50419042101 |
UN |
1 IUD |
This is an IUD. |
UN1 |
J9308 |
5 mg |
00002767801 |
ML |
800 mg |
Concentration is 500 mg/ 50 ml, which means for every 500 mg given, 50 ml is administered. (800/500)*50=80 |
ML80 |
For your convenience, here’s a list of all codes that have been identified and sorted by NDC.
Procedure |
Procedure code billable units** |
NDC code |
NDC billable unit** |
Dose example |
Tip for determining the NDC quantity (units) |
NDC quantity*** (for dose example) |
J9308 |
5 mg |
00002767801 |
ML |
800 mg |
Concentration is 500 mg/ 50 ml, which means for every 500 mg given, 50 ml is administered. (800/500)*50=80 |
ML80 |
J3301 |
10 mg |
00003029328 |
ML |
40 mg |
Concentration is 40 mg/ml, which means for every 40 mg given, 1 ml is administered. |
ML1 |
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=3) |
UN3 |
90670 |
0.5 ml |
00005197101 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90670 |
0.5 ml |
00005197102 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90649 |
N/A |
00006404500 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90649 |
N/A |
00006404501 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90649 |
N/A |
00006404541 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90680 |
N/A |
00006404741 |
ML |
2 ml |
Amount administered |
ML2 |
90744 |
1 dose |
00006409302 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90633 |
N/A |
00006409502 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90651 |
N/A |
00006411903 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90651 |
N/A |
00006412102 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90710 |
N/A |
00006417100 |
UN |
1 vial |
Combination vaccine; 1 dose equals 1 vial. |
UN1 |
90707 |
N/A |
00006468100 |
UN |
1 dose |
Combination vaccine; bill number of vials used (1 dose equals 1 vial). |
UN1 |
90732 |
0.5 ml |
00006473900 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90716 |
N/A |
00006482700 |
UN |
|
Concentration is 1350 units/vial; bill number of vials used (one dose equals one vial). |
UN1 |
90633 |
N/A |
00006483101 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90633 |
N/A |
00006483141 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90647 |
N/A |
00006489700 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90732 |
0.5 ml |
00006494300 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
00006498100 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90710 |
N/A |
00006499900 |
UN |
1 vial |
Combination vaccine; 1 dose equals 1 vial. |
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 |
J1071 |
1 mg |
00009041702 |
ML |
200 mg |
Concentration is 200 mg/ml, which means for every 200 mg given, 1 ml is administered. |
ML1 |
J1050 |
1 mg |
00009062601 |
ML |
400 mg |
Concentration is 400mg/1ml, which means for every 400 mg, 1 ml is administered. |
ML1 |
J1050 |
1 mg |
00009737611 |
ML |
150 mg |
Concentration is 150MG/1ml, which means for every 150 mg given, 1 ml is administered. |
ML1 |
J0585 |
1 unit |
00023114501 |
UN |
200 units |
Vial contains 100 units; bill number of vials used (200 divided by 100). |
UN2 |
J0585 |
1 unit |
00023392102 |
UN |
200 units |
Vial contains 200 units; bill number of vials used. |
UN1 |
J2353 |
1 mg |
00078064781 |
UN |
40 mg |
Vial contains 20 mg, which means when 40 mg are given, 2 vials are administered. |
UN2 |
J7309 |
1 g |
00299630002 |
GR |
1 g |
Amount administered |
GR1 |
J0171 |
0.1 mg |
00409724161 |
ML |
1 mg |
Concentration is 1mg/ml, which means for every 1 mg given, 1 ml is administered. |
ML1 |
J0598 |
10 units |
42227008105 |
UN |
1,000 units |
500 units per vial
(1,000/500=2 vials). |
UN2 |
90620 |
0.5 ml |
46028011401 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90734 |
N/A |
46028020801 |
Determine by product used: If it’s a powder that needs to be reconstituted or an oral tablet, use UN. If it’s liquid in vial, use ML |
0.5 ml |
Vial contains complete dose. |
UN1 |
90700 |
N/A |
49281028610 |
ML |
0.5 ml |
Amount administered |
M 0.5 |
90715 |
0.5 ml |
49281040010 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90715 |
0.5 ml |
49281040015 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90715 |
0.5 ml |
49281040058 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90715 |
1 dose |
49281040088 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90698 |
N/A |
49281051005 |
UN |
1 dose |
Combination vaccine; bill number of vials used (1 dose equals 1 vial). |
UN1 |
90685 |
0.25 ml |
49281051525 |
ML |
0.25 ml |
Amount administered |
ML0.25 |
90734 |
N/A |
49281058905 |
Determine by product used: If it’s a powder that needs to be reconstituted or oral tablet, use UN. If it’s liquid in a vial, use ML |
0.5 ml |
Amount administered |
ML0.5 |
90734 |
N/A |
49281058958 |
Determine by product used: If it’s a powder that needs to be reconstituted or oral tablet, use UN. If it’s liquid in a vial, use ML |
0.5 ml |
Amount administered |
ML0.5 |
90688 |
0.5 ml |
49281062315 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90654 |
0.1 ml |
49281070848 |
ML |
0.1 ml |
Amount administered |
ML0.1 |
90713 |
N/A |
49281086010 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
J2357 |
5 mg |
50242004062 |
UN |
300 mg |
Vial contains 150 mg, which means when 300 mg are given, 2 vials are administered. |
UN2 |
J9310 |
100 mg |
50242005121 |
ML |
100 mg |
Concentration is 10 mg/ml, which means for every 10 mg given, 1 ML is used. Since 100 mg was given, 10 mg is administered (100 divided by 10). |
ML10 |
J9035 |
10 mg |
50242006001 |
ML |
100 mg |
Concentration is 25 mg/ml, which means for every 25 mg given, 1 ml is used. Since 100 mg was given, 4 ml is administered (100 divided by 25). |
ML4 |
J2778 |
0.1 mg |
50242008001 |
ML |
0.5 mg |
Concentration is 0.5 mg/0.05 ml, which means for every 0.5 mg given, 0.05 ml is administered. |
ML0.05 |
J9355 |
10 mg |
50242013468 |
UN |
440 mg |
Concentration is 440 mg /vial; bill number of vials used. |
UN1 |
J7298 |
N/A |
50419042101 |
UN |
1 IUD |
This is an IUD. |
UN1 |
J7298 |
N/A |
50419042301 |
UN |
1 IUD |
This is an IUD. |
UN1 |
J0717 |
1 mg |
50474070062 |
UN |
400 mg |
Concentration is 400 mg per vial. |
UN1 |
J2505 |
6 mg |
55513019001 |
ML |
6 mg |
Concentration is 6 ml/0.6 ml, which means for every 6 mg given, 0.6 ml is administered. |
ML0.6 |
J0897 |
1 mg |
55513073001 |
ML |
120 mg |
Concentration is 120 mg/1.7 ml, which means for every 120 mg given, 1.7 ml is administered. |
ML1.7 |
J1745 |
10 mg |
57894003001 |
UN |
100 mg |
Vial contains 100 mg; bill number of vials used. |
UN1 |
J3357 |
1 mg |
57894006103 |
ML |
90 mg |
Concentration is 90 mg/ ml, which means for every 90 mg given, 1 ml is administered. |
ML1 |
90700 |
N/A |
58160081011 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90700 |
N/A |
58160081052 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90723 |
N/A |
58160081152 |
ML |
1 dose |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90696 |
N/A |
58160081211 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90696 |
N/A |
58160081252 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
58160082011 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90744 |
1 dose |
58160082052 |
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 |
90715 |
0.5 ml |
58160084211 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
90715 |
0.5 ml |
58160084252 |
ML |
0.5 ml |
Combination vaccine; 1 dose equals 0.5 ml. |
ML0.5 |
90686 |
0.5 ml |
58160090352 |
ML |
0.5 ml |
Amount administered |
ML0.5 |
J7325 |
1 mg |
58468009003 |
ML |
48 mg |
Concentration is 48 mg/6 ml, which means for every 48 mg given, 6 ml is administered. |
ML6 |
J1050 |
1 mg |
59762453701 |
ML |
150 mg |
Concentration is 150 mg/1 ml, which means for every 150 mg given, 1 ml is administered. |
ML1 |
J0178 |
1 mg |
61755000502 |
ML |
2 mg |
Concentration is 2 mg/0.05 ml, which means for every 2 mg given, 0.05 ml is administered. |
ML0.05 |
J3380 |
1 mg |
64764030020 |
UN |
300 mg |
Concentration is 300 mg per vial. |
UN1 |
J0878 |
1 mg |
67919001101 |
UN |
500 mg |
Vial contains 500 mg units; bill number of vials used. |
UN1 |
J7321 |
Per dose |
89122072420 |
ML |
20 mg |
Concentration is 10 mg/ml, which means for every 10 mg given, 1 ml is used. Since 20 mg were given, 2 ml is administered (20 divided by 10). |
ML2 |
J7321 |
Per dose |
89130444401 |
ML |
25 mg |
Concentration is 10 mg/ml, which means for every 10 mg given, 1 ml is used. Since 25 mg was given, 2.5 ml is administered (25 divided by 10). |
ML2.5 |
See the April 2016 Record and May 2016 Record for tips on submitting electronic claims. For tips on submitting paper claims, see the February 2015 Record.
**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).
None of the information included herein is intended to be legal advice and as such it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.
|
