Results 1 to 3 of 3

Billing drugs when less then stated quantity given

  1. Default Billing drugs when less then stated quantity given
    Medical Coding Books
    How would you bill for a drug when the amount administered is less than the amount stated in the HCPCS. Example J2430 is per 30 mg. If provider administers 15 mg, how would you bill for this? The remainder is not considered wastage.

  2. Default
    To my knowledge you would bill for one unit as units are reported in whole cannot report 1/2 a unit on a claim.

    If the dosage given exceeds the per unit dose (hcpcs descriptor) you would round up...

    For ex. descriptor indicates per 30 mg....If 40mg were given you'd bill 2 units
    (1 unit for the 1st 30 mg, the 2nd unit to capture the add'l 10 mg)

    I do not have a reference at this time, however I believe CMS has addressed it.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  3. Default
    “When the dosage amount is greater than the amount indicated for the HCPCS code,
    the facility rounds up to determine units. When the dosage amount is less than the
    amount indicated for the HCPCS code, use 1 as the unit of measure.”

    Correct Reporting of Units for Drugs
    Hospitals and providers are reminded to ensure that units of drugs administered to patients are accurately reported in terms of the dosage specified in the full HCPCS code descriptor. That is, units should be reported in multiples of the units included in the HCPCS descriptor. For example, if the description for the drug code is 50 mg, but 200 mg of the drug was administered to the patient, the units billed should be 4. Providers and hospitals should not bill the units based on the way the drug is packaged, stored, or stocked. That is, if the HCPCS descriptor for the drug code specifies 1 mg, and a 10 mg vial of the drug was administered to the patient, bill 10 units, even though only 1 vial was administered. HCPCS short descriptors are limited to 28 characters, which includes spaces, so short descriptors do not always capture the complete description of the drug. Therefore, before submitting Medicare claims for drugs and biologicals, it is extremely important to review the complete long descriptors for the applicable HCPCS codes.
    The full descriptors for the Level II HCPCS codes can be found in the latest code books or from the latest Level II HCPCS file, which is available for downloading from the CMS Web site at:
    Providers are reminded to check HCPCS descriptors for any changes to the units when HCPCS definitions or codes are changed.
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

Similar Threads

  1. MI without stated duration
    By in forum Cardiology
    Replies: 3
    Last Post: 07-16-2014, 07:20 AM
  2. Quantity billing for cpt code 88305
    By tholcomb in forum Pathology & Clinical Laboratory
    Replies: 3
    Last Post: 08-22-2013, 07:16 PM
  3. Quantity Billing for cpt 88305
    By tholcomb in forum Pathology & Clinical Laboratory
    Replies: 2
    Last Post: 06-12-2013, 11:24 AM
  4. Quantity Billing for derm path codes
    By tholcomb in forum Pathology & Clinical Laboratory
    Replies: 2
    Last Post: 10-09-2012, 09:09 AM
  5. Quantity billing 90862
    By 1073358 in forum Behavioral Health
    Replies: 7
    Last Post: 09-22-2009, 02:32 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.