Injectable Drugs - General Information

Injectable drugs are part of many hospital and outpatient therapies. This section provides specific instructions for billing HMSA for injectable drugs (e.g., erythropoietin, vaccines).

Payment policy

Payment for injectable drugs, administration and ancillary services (e.g., radiology and laboratory services) is the eligible charge less any member copayment and/or deductible.

Note: Unless otherwise noted, the policies and claims filing instructions outlined in this section do not apply to Medicare Advantage plans.

Place of service

Injectable drugs can be administered in outpatient and inpatient settings, skilled nursing facilities (SNFs) and in the patient's home. The policies and claims filing instructions outlined in this section apply to outpatient settings only.

Service units

The administration of an injectable drug is considered one unit and must be billed as such. The number of units in form locator 46 on the UB-04 should never be greater than one per line item when billing an administration revenue code.

Service dates

The administration of the drug and the drug itself must be billed with the same service date.

Revision History