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July 2016

Reminder: Follow billing guidelines when purchasing, administering medical drugs to outpatients

When a hospital purchases and administers a medical drug for a Blue Cross Blue Shield of Michigan member who is an outpatient, the hospital should bill the revenue code and corresponding procedure code for both the drug and its administration, using separate revenue lines.

See the example below:

When a hospital administers a drug in an outpatient setting that isn’t purchased by the hospital, the hospital should bill for the administration. However, the hospital should include the revenue code and corresponding procedure code for the medical drug with total charges of $.01.

See the example below:

2

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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