Payment Policy
When Revenue Code 637 is billed on an emergency room (ER), outpatient surgical procedure-related group (PRG), diagnosis-related group (DRG), observation, or labor room case claim, the Revenue Code 637 service will be included in the case rate.
However, if the cost of a particular Revenue Code 637 line is exceptionally high and is a medically necessary drug, the provider can submit a written request for review by the HMSA staff. The Revenue Code 637 line charge drug cost must exceed the case rate and be greater than $1,000.
Please send a written request with your supporting documentation to the address listed below.
HMSA – Provider Operations
ATTN: Research and Correspondence
P.O. Box 860
Honolulu, HI 96808-0860
Incidental Drugs
| Revenue Code | Description | Level of Code | Description |
|---|---|---|---|
| 637 | Self-administered drugs | HCPCS | Use HCPCS codes that describe the services rendered. |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |