Article Detail - JD DME
Levalbuterol - Billing Guidelines
Original Effective Date: 07/01/2005
Revision Effective Date: 11/01/2013
The unit of service for billing levalbuterol inhalation solution in unit dose vials (J7614) is 0.5 milligrams (mg). Levalbuterol is provided in dosages that are different. This difference has caused some confusion regarding the proper calculation for the number of units to be billed to Medicare. The number of units of service that must be billed on the claim are determined as follows:
1. Calculate the total milligrams of levalbuterol that are provided for the month.
For example, Xopenex brand levalbuterol comes in unit dose vials each containing 0.31 mg, 0.63 mg, and 1.25 mg of levalbuterol. If 90 of the 0.63 mg vials are dispensed, then the number of milligrams dispensed is 90 x 0.63 = 56.7 mg.
2. Multiply the result from step 1 times 2 to determine the number of units of service (UOS).
For example, 56.7mg x 2 UOS/mg = 113.4 UOS.
3, Round the result from step 2 up to the next highest whole number (if the result in step 2 is not already a whole number) and bill that number of units on the claim.
For example, round 113.4 up to 114 UOS and bill that on the claim.
- DO NOT determine the number of UOS per vial and use that in the calculation. In the example given,
- DO NOT say that each 0.63 mg represents 2 UOS.
- DO NOT bill 180 UOS when 90 of the 0.63 mg vials are dispensed.
IMPORTANT NOTE: The amount of drug in a vial can be expressed as either levalbuterol or levalbuterol hydrochloride (HCl). The calculation used to determine the UOS must use the value for levalbuterol, NOT levalbuterol HCl. For example, Xopenex brand levalbuterol comes in unit dose vials containing 0.31 mg, 0.63 mg, and 1.25 of levalbuterol. (These correspond to 0.36 mg, 0.73 mg, and 1.44 mg of levalbuterol HCl, respectively.) The 0.36, 0.73, and 1.44 values must NOT be used in the calculation of units of service.
When claims are billed in NCPDP format using NDC numbers, different instructions may apply. Refer to the NCPDP Companion Document available through the CMS web site.
Last Updated Wed, 10 May 2017 11:04:26 +0000