# HCPCS/CPTs Required with Revenue Codes?



## sfritch (Nov 9, 2012)

Greetings! Can anyone offer information on the following?

I work in a payer's office and our intent is to follow Uniform Billing Editor guidelines whenever possible for processing claims from facilities. For pharmacy billing (revenue codes 025x), an excerpt from the UB guidelines states, "HCPCS codes for packaged drugs and biologicals are not required, but CMS strongly urges that OPPS hospitals report the correct HCPCS codes for the items used."

Per our current policy, some drugs require prior auth, but when facilities bill revenue 025x without a HCPCS code, we are unable to identify the drugs administered, and therefore unable to determine authorization. Some facilities even bundle numerous drugs into a single claim line with only the revenue code.

Are other commercial payers requiring that HCPCS be billed with revenue codes despite the UB non-requirement? Are you seeing revenue/HCPCS coding combinations for other categories of service besides pharmacy?

Any information is greatly apprectiated!!


----------



## airart (Nov 28, 2012)

*Answer is request a Super Bill of services*

I worked with many insurances processing hospital claims and most of the time they would send along the super bill or charge sheet of all the services broken down line by line so it was easy to determine what was charged.  On the super bill or charge sheet the CPT/HCPC drugs are listed along with how many units were used etc.  This made it easier to place what was covered and which were not.  Hopefully you can request this from your providers if they are not already doing so.


----------



## sfritch (Dec 3, 2012)

*Thank you!*

Thank you airart for your time and answer! This is helpful.


----------

