CMS Provides Clarification for Hospitals on How to Correctly Bill for Drugs and Units Charged

June 30, 2006

CMS Provides Clarification for Hospitals on How to Correctly Bill for Drugs and Units Charged

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 four.

Note: Providers and hospitals should not bill the units based on the way the drug is packaged, stored, or stocked. 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 one 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 http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage on the CMS web site.

Note: Providers are reminded to check HCPCS descriptors for any changes to the units when HCPCS definitions or codes are changed.