Billing Unit Decision Tree

 
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This Decision Tree will help you determine which billing unit to use.

Possible end-points include EACH, MILLILITER, GRAM or inconclusive.

Inconclusive results should be handled by communicating with NCPDP Work Group 2 leaders.

To find your billing unit, please answer the following YES or NO questions.

  • Yes. Let's begin the decision tree.
1

Is the product one of the following:

Epinephrine single dose injection devices (e.g., EpiPen®, EpiPen Jr®)

Moviprep® and generics of Moviprep®

  • Yes. It is one of the above exceptions.
  • No. Not one of these exceptions.
2

Is the product one of the following:

• Single Use Powder Packets for reconstitution (like QuestranTM or ZmaxTM)

• Antihemophilic Factors (like NovoSevenTM)

• Alpha-1-Proteinase Inhibitors (like ProlastinTM)

  • Yes. It is one of the above exceptions.
  • No. Not one of these exceptions.
3

Is the product a "Bulk" Chemical?

(this includes nystatin)

  • Yes
  • No. It is NOT a bulk chemical.
4

Does the final product have more than one distinct billing unit within package?

In other words, does package contain a mixture of items that are obviously different billing units, like grams with milliliters, or eachs with milliliters?

For example, does it contain tablets along with filled syringes?

  • Yes.
  • No. The final product does not seem to have a combination of different billing units.
5

Is there a non-drug item included that helps to administer drug?

  • Yes
  • No. Nothing in package helps with drug administration.
6

Does is have one or more of these non-drug items?

Medicated wipes

Alcohol swabs and/or cotton balls

Meters packaged with test strips

  • Yes.
  • No. No wipes, no swabs, no cotton balls, nor meter w/ strips.
7

Is product dispensed in discreet units not measured by volume or weight.

Examples include:

a patch,

a tablet,

a capsule,

a suppository,

a powder-filled blister, or

an implant

  • Yes.
  • No. It does NOT have a discreet unit, such as a tablet.
8

Is it one of these?

an inhaler,

a topical solid,

a semi-solid,

a cream, or

a gel

  • Yes.
  • No. It is NOT one those.
9

Does the manufacturer state the package size in GRAMS or MILLILITERS?

  • Yes. I think so.
  • No. No references to GRAMs or MILLILITERs package size.
10

Does the manufacturer clearly state the package size in MILLILITERS?

  • Yes.
  • No. In fact, it states GRAMS.
11

Is it a liquid?

(and the medicine does NOT need to be reconstituted before patient administration)?

  • Yes.
  • No. Not a liquid.
12

Does it contain other non-drug items such as:

• Syringes

• Mixing containers

• Needles

• Nit combs

• Diluents

• Measuring device

• Tubing for administration

• Finger cots

• Applicators

• Oral syringes

• Actuation devices (i.e.lancets, lancet devices)

• mandatory patient education information

• inhalation aid (i.e. spacer)

  • Yes.
  • No. It does NOT contain any of those things.
13

Is it an injection?

  • Yes.
  • No. Not an injection.
14

Does the container have less than 1 mL?

  • Yes.
  • No. It contains 1 mL or more.
15

Is it powder for reconstitution?

  • Yes.
  • No. It does not need to be reconstituted.
16

Is it for injection?

  • Yes.
  • No. It will not be injected.
17

Is it a mulit-dose container?

  • Yes.
  • No. It is not multi-dose.
123

These are grandfathered exceptions:

Epinephrine single dose injection devices - one EACH (1 billing unit per single dose injection device)

Moviprep® and generics of Moviprep® – one EACH (1 billing unit per carton)

124

These are exceptions to the billing unit standard:

• Powder packet: billing unit = EACH packet

   (For example: QuestranTM 60 pkts = 60 billing units)

• AHF: billing unit = EACH international unit (iu) or μg

• Alpha-1-Proteinase Inhibitors: billing unit = EACH international unit (iu)

125

It depends how it's labeled and if it has variable potencies:

• Bulk Chemicals where labeled in grams, billing unit = GRAMS

• Bulk Chemicals where labeled in milliliters, billing unit = MILLILITERS

• Bulk Chemicals that have variable potencies, billing unit = EACH

127

Likely billed per EACH

 
128

Likely billed per MILLILITER

 
129

Likely billed per GRAM

 
130

Inconclusive

Probably billed per EACH kit.

However, kits can be confusing.

Therefore, please submit a request to NCPDP Work Group 2 for review.

131

Inconclusive

Please submit request to NCPDP Work Group 2 for review.

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Disclaimer:

This decision tree tool is NOT intended to be used as the final verification when choosing billing units.

Please use as a PRELIMINARY GUIDE before consulting the NCPDP Work Group 2 leadership.

The Billing Unit Decision Tree is provided to the user "AS IS", WITHOUT GUARANTEE of its accuracy.

ANY MATERIAL, DATA, or ANSWER OBTAINED THROUGH USE OF THE BILLING UNIT DECISION TREE IS AT USER'S OWN DISCRETION.

NCPDP, and all contributors of this tool, are NOT RESPONSIBLE FOR ANY RESULTING DAMAGE.

  • Yes. I understand and I agree to use at my own risk. Please continue.
  • No.

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