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Billing Tips: Pharmacy Claims

Instructions for completing the Metric Quantity fields (Boxes 13, 32, 51 and 70 as applicable).

  • Enter the quantity of the entire amount dispensed and being billed on the claim.
  • Quantities must be in metric decimal format.
  • Do not include a decimal in either of the two boxes of the Metric Quantity field or the claim will be returned.
  • The “Decimal” field must include trailing zeros, for a total of three digits.
  • Do not use measurement units, such as “Gm” or “cc”.
  • Entries should properly align within their intended fields.

Example 1: For a 2.5 Gm ointment, providers should enter 2 in the Whole Units box and 500 in the Decimal box.
Pharmacy Claims Billing Tip Example 1

Example 2: For three, 2.5 cc ampules, providers should enter 7 in the Whole Units box and 500 in the Decimal box (3 x 2.5 = 7.5).
Pharmacy Claims Billing Tip Example 2

Example 3: For an 8 cc ampule with no decimal numbers, providers are still required enter three zeros in the Decimal box.
Pharmacy Claims Billing Tip Example 3

If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.



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