Date

Providers must bill the correct quantities for medications dispensed to participants in the outpatient hospital setting.  Section 15.24.E of the Hospital Provider Manual states the quantity to be billed for injectables and other types of medications dispensed to MHD participants must be calculated as follows:

  • Containers of medication in solution (for example, ampoules, bags, bottles, Vials, syringes) must be billed by exact cubic centimeters or milliliters (cc or ml) dispensed, even if the quantity includes a decimal (e.g., if three (3) 0.5 ml vials are dispensed, the correct quantity to bill is 1.5 mls).
  • Single dose syringes and single dose vials must be billed per cubic centimeters or milliliters (cc or ml), rather than per syringe or per vial.
  • Ointments must be billed per number of grams even if the quantity includes a decimal.
  • Eye drops must be billed per number of cubic centimeters or milliliters (cc or ml) in each bottle even if the quantity includes a decimal.
  • Powder filled vials and syringes that require reconstitution must be billed by the number of vials.
  • Combination products, which consist of devices and drugs, designed to be used together, are to be billed as a kit. Quantity will be the number of kits used.
  • The product Herceptin, by Genentech, must be billed by milligram rather than by vial due to the stability of the drug.
  • Non-VFC Immunizations and vaccines must be billed by the cubic centimeters or milliliters (cc or ml) dispensed, rather than per dose.