Sunday, October 3, 2010

CMS 24 (Unnamed Shaded Area)

24 (Unnamed Shaded Area)
Enter the following information in the shaded area of Lines 1-6
from the beginning of 24A to the end of 24G for up to 61
For Drugs or Injectable Devices Administered in the Office:
If billing for drugs or injectable devices administered in the office,
except vaccines, enter the following information:
• Qualifier N4;
• the national drug code (NDC);
• the NDC unit of measure; and
• the quantity of the drug administered.
This information is in addition to the Healthcare Common
Procedure Coding System (HCPCS) code entered in the unshaded
section on the same line. Use the following qualifiers when
reporting NDC units:
• F2: international unit (for example, anti-hemophilia factor);
• GR: gram (for creams, ointments, and bulk powders);
• ML: milliliter (for liquids, suspensions, solutions, and lotions);
• UN: unit (for tablets, capsules, suppositories, and powder-filled

For Medical Supplies:
If billing for medical supplies that do not require prior authorization
and are listed in Subchapter 6 (service codes and descriptions) of
your MassHealth provider manual as requiring individual
consideration (IC), and do not require prior authorization, enter a
complete description of the item and the acquisition cost in addition
to the quantity dispensed, and attach a copy of the supplier’s
invoice. Invoices submitted with a claim must be dated no more
than 18 months before the date of service. One invoice indicating
all the items for which payment is requested is acceptable.

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