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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.39 Medications - Injectable : 8.2.39.27 Unit Calculations for Billing Drugs

8.2.39.27
Providers must calculate the number of units to be billed on the claim based on the number of units indicated in the procedure code description and the amount of the drug actually administered. Providers should refer to the procedure code description for the unit amount to calculate the number of units to be billed.
The formula to use to calculate the appropriate quantity of units to bill is:
Amount administered divided by the units indicated in the procedure code description.
For example:
Refer to:
Claims submitted with incorrect unit calculations may cause delayed or incorrect payment.
The specific NDC of the drug actually dispensed should be entered on the claim form. Additional information about entering NDC codes is available on the NDC page of the TMHP website at www.tmhp.com.

Texas Medicaid & Healthcare Partnership
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