Greetings! Can anyone offer information on the following?
I work in a payer's office and our intent is to follow Uniform Billing Editor guidelines whenever possible for processing claims from facilities. For pharmacy billing (revenue codes 025x), an excerpt from the UB guidelines states, "HCPCS codes for packaged drugs and biologicals are not required, but CMS strongly urges that OPPS hospitals report the correct HCPCS codes for the items used."
Per our current policy, some drugs require prior auth, but when facilities bill revenue 025x without a HCPCS code, we are unable to identify the drugs administered, and therefore unable to determine authorization. Some facilities even bundle numerous drugs into a single claim line with only the revenue code.
Are other commercial payers requiring that HCPCS be billed with revenue codes despite the UB non-requirement? Are you seeing revenue/HCPCS coding combinations for other categories of service besides pharmacy?
Any information is greatly apprectiated!!
I work in a payer's office and our intent is to follow Uniform Billing Editor guidelines whenever possible for processing claims from facilities. For pharmacy billing (revenue codes 025x), an excerpt from the UB guidelines states, "HCPCS codes for packaged drugs and biologicals are not required, but CMS strongly urges that OPPS hospitals report the correct HCPCS codes for the items used."
Per our current policy, some drugs require prior auth, but when facilities bill revenue 025x without a HCPCS code, we are unable to identify the drugs administered, and therefore unable to determine authorization. Some facilities even bundle numerous drugs into a single claim line with only the revenue code.
Are other commercial payers requiring that HCPCS be billed with revenue codes despite the UB non-requirement? Are you seeing revenue/HCPCS coding combinations for other categories of service besides pharmacy?
Any information is greatly apprectiated!!
