- Change to Roster Claims Information Entry in the Fiscal Intermediary Standard System Direct Data Entry
- Drugs and Biologicals - Coverage and Billing
- Medicare Part B Drug Coverage
- Covered Medicare Part B Drugs/Biologicals
- Self-Administered Drug Exclusion
- Medicare Part B General Billing
- Discarded Drugs/Wastage and JW, JZ Modifier
- Chemotherapy General Infusion Information
- Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)
- Compound Drugs
- Patient-Supplied or Free-of-Charge Drugs
- Prolonged Drug and Biological Infusions Using an External Pump
- Coding for Sinuva™ Claims
- Radiopharmaceutical Reimbursement
- Dermal Injections for Treatment of Facial Lipodystrophy Syndrome
- Factor VIII Billing
- Intravitreal Beovu (Brolucizumab-dbl) Billing
- Proper Billing for LEQVIO® HCPCS Code J1306
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Proper Billing for TEZSPIRE™ HCPCS Code J2356
- Proper Billing Units for HCPCS Code J7320
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Skin Substitutes
- Vaccines
- Related Content
Factor VIII Billing
National Government Services has received questions on the proper billing for Factor VIII drugs. This article outlines appropriate billing for these services.
- If the submitted amount does not exceed $99,999.99, bill the claim on one line of service with one unit of service. Submit the actual units of Factor VIII in the SV101-7 segment of Loop 2300 or Loop 2400.
- If the claim does not exceed 9,999 units, which are the maximum units allowed per claim line, bill with the total units of service on that claim line. The claim line should be identical in the submitted amount or units of service if billing multiple units on the same claim. This allows the system to differentiate the claim from being a duplicate. If billing multiple lines to include the total units provided, append modifier 76 to the Factor VIII code billed. Also, remember you cannot exceed the MUE on any single line billed or the service will automatically reject.
- If the submitted amount exceeds $99,999.99, split the service into two claims if billing electronically. The submitted amount will be truncated if a dollar amount higher than $99,999.99 is submitted. Paper claims can be split since the entire dollar amount shows up, or you may submit the charges as two claims. Either way you must submit the units of service in item 19 on the CMS -1500 form.
- The comments provided with the claim submission help the provider and NGS avoid development of the claim when each line clearly states the amount dispensed and the claim comment screen states the dose and frequency in the claim (Loop 2300) NTE Segment. If comments are left out, claim development will occur to obtain the information.
Regardless of which method you utilize in submitting your Factor VIII claims it is imperative that you indicate the total units on the claim(s), and if the claim is 1 of 2 submitted for the same date of service in instances where you need to split the claim for submission. Following these guidelines will avoid claim denials for inappropriate billing.
Reviewed 3/26/2024