Wednesday, June 15, 2016

Drug Billing on CMS 1500 AND UB 04 -


• Drug Billing

o Providers are required to bill GHP with the applicable NDC and CPT/HCPCs codes for drugs.

** Reporting NDC on a CMS-1500 claim form

• Enter the NDC in the shaded sections of item 24A through 24G

o To enter the NDC information, enter the qualifier and then the 11 digit NDC information. Please enter the information without hyphenation.

o Providers are to bill each drug for a compound medication as a separate line item with the appropriate NDC.

• Enter the drug name and strength

• Enter the NDC quantity unit qualifier

• Enter the NDC quantity


** Reporting NDC on a UB-04 claims form

• Enter the NDC in the revenue description field (form locator 43)

o To enter the NDC information, enter the qualifier in the first two positions, left-justified, followed immediately by the 11 character NDC without hyphenation.

• Enter the NDC quantity unit qualifier

• Enter the NDC quantity

** Reporting NDC through EDI

• The NDC is to be billed in loop 2410 LIN3

o Reimbursement for specialty pharmaceuticals (i.e. hematology/oncology drugs), will follow Medicaid reimbursement guidelines.


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