Forum - Questions & Answers

Jun 3rd, 2009 - jfdoffice 14 

Billing medication units

The HCPCS code S0020 for Marciane (bupivicaine HCL) is for 30 ml, not in mg/cc. Is the 30 ml considered 1 unit for this code? If so, when using 3 ml ( equal to 15mg Marcaine for the 5mg/ml solution) in a trigger point injection, the 3cc is actually 0.1 unit of the 30ml code. Is this correct? Then a 6cc amount is billed as 0.2 units?

Jun 3rd, 2009 - nmaguire   2,606 

ml

ml's stands for milliliters
One cc = one ml They are equivalent

Jun 3rd, 2009 - jfdoffice 14 

billing medication units

I understand that 1cc = 1ml. My question refers to how to code the units when the 20020 code specifies 30 ml. We do not give the entire 30 ml -- we give 3 ml in a combination injection with 2 other medications. The 3 ml is one tenth of the 30 ml specified in the code.

Jun 4th, 2009 - Codapedia Editor 1,399 

billing medication units

This looked to me like a math question ("If a train leaves Chicago...) so I ignored it.

But, on closer inspection, let me ask this: If a physician office gives less than one unit of a medication, as defined my HCPCS, how is it billed?

http://www.cms.hhs.gov/Manuals/IOM/list.asp
This is from the Medicare Claims Processing Manual, (Pub 100-04) Chapter 17, Section 10


If the full dosage provided is less than the dosage for the HCPCS code descriptor specifying the minimum dosage for the drug, the provider reports one unit of the HCPCS code for the minimum dosage amount.

Jun 4th, 2009 - jfdoffice 14 

Billing medication units

Thank you for your second look at my question! Before asking your assistance, I looked carefully at the S0200 code and it does not state "up to" but does have the "quantitiy alert" check next to the code. One source had advised me to enter in the drug description the amount in mg/cc, i.e. 5mg/cc; the units for the 15mg dosage would be 3. The source advised me that the insurance company would recognize the code as having a "quantity alert" and would adjust the payment accordingly. That seemed to disregard the 30ml descriptor. Prior to that recommendation, I had intended to report one unit as you advise. Thank you for the clarification.
One additional thought -- the introductory paragraph to the S codes states they are "private" insurer codes developed by BCBS (et al.) for private insurer use and not payaable by Medicare. Would that alter referencing the Medicare Manual?



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