Oncology & Hematology Coding Alert

HCPCS Tip: Make the Most of Medicare’s Unit Calculation Rules


- Published on Fri, Dec 09, 2011

While you're reviewing HCPCS 2012 updates with your practice, take a moment to go over Medicare's policy on calculating units. Reporting units correctly is crucial to accurate claims and appropriate reimbursement.

You'll find helpful instructions in the Medicare Claims Processing Manual, 100-04, chapter 17, section 70 (www.cms.gov/manuals/downloads/clm104c17.pdf).

Example: Among the rules and examples, you'll find the important instruction that "When the dosage amount is greater than the amount indicated for the HCPCS code, the facility rounds up to determine units." If your staff doesn't know to round up in these cases, your practice could be leaving legitimate reimbursement on the table.



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