Knowledge Base Article

Q:

How do you report the quantity of a drug with a HCPCS code when the HCPCS dose is different from the dose that was given?

A:

You can round up the quantity when needed with any of the drug HCPCS codes.

So if the HCPCS code is “per 5 MG” and you gave 10 MG, you would report the HCPCS code with a quantity of 2. If the HCPCS code is “per 5 MG” and gave 8 MG, you would round up and report the HCPCS code with a quantity of 2.

Reference: Medicare Claims Processing Manual, chapter 17, section 10

“Hospitals must report all appropriate HCPCS codes and charges for separately payable drugs, in addition to reporting the applicable drug administration codes. Hospitals should also report the HCPCS codes and charges for drugs that are packaged into payments for the corresponding drug administration or other separately payable services. Historical hospital cost data may assist with future payment packaging decisions for such drugs. Drugs are billed in multiples of the dosage specified in the HCPCS code long descriptor. If the drug dose used in the care of a patient is not a multiple of the HCPCS code dosage descriptor, the provider rounds to the next highest unit based on the HCPCS long descriptor for the code in order to report the dose provided. 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.”