When billing unlisted codes, the unit of service equals one and the following details must be entered into in Item 19 of the CMS-1500 or the electronic claim equivalent (Loop 2400/SV101-7):

• Name of the drug
• Dose administered (mg, cc, etc.)
• Route of administration (IV, IM, SC, PO, etc.)
• The invoice price (for new drugs if the WAC is unavailable, or for compounded drugs)

For additional information and guidance, visit Drugs and Biologicals – Coverage and Billing.