HCPCS & CPT coding

Billable unit

Definition

The quantity denominator built into a HCPCS drug code, which converts an administered dose into the number reported on the claim.

The descriptor states it: injection, pembrolizumab, 1 mg means one unit equals one milligram. Injection, infliximab, 10 mg means a 400 mg dose is 40 units.

Units are the single largest source of drug-claim overpayment and underpayment. A code whose unit is 10 mg, billed as though it were 1 mg, overstates the claim tenfold and is a standard audit target.

J-codeA HCPCS Level II code beginning with J that identifies a drug administered by a clinician rather than self-administered.Definition NDC quantityThe amount of drug actually taken from the package, expressed in the unit named by the unit qualifier.Definition Unit qualifierA two-character code stating the unit in which the NDC quantity is expressed.Definition JW modifierReports the amount of a single-dose container that was discarded rather than administered.Definition

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Billable unit

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