Drug Unit Calculator
Instructions
Found in the Provider's order
HCPCS / CPT Code & Drug Name
Dosing Schedule
Data to input in the calculator
1. What is the Unit Dose for the drug being requested?
2. What dosage will be administered during each visit?
3. How many doses will be administered through the period being requested?
Calculation
Please enter all 3 items:
Unit Dose:
Dosage Per Visit:
Number of Doses:
Total Units Requested:
Notes
1.The unit of measurement (i.e. mg, grams, mLs, ccs, IUs) noted in the "HCPCS / CPT Code & Drug Name" and the "Dosing Schedule" must be the same. If they do not match, the calculation for the "Total # of Units To Be Requested" will be incorrect. For example, they must both be in "mg". See "Example 3" for an instance when the unit of measurement needs to be converted in order for them to both match.2.When entering the "Number of Doses," make sure to account for additional doses if for example two eyes are being treated during each visit. See "Example 2" below.
3.Ensuring the accuracy of the Total # of UNITS being requested is the responsibility of the requesting provider.
EXAMPLE 1
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg (Treating One Eye)
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg (Treating One Eye)
What is the HCPCS / CPT Code & Drug Name being requested?
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar,
0.1 mg
What is the dosing schedule?
(This is the order that the provider has written.)
(This is the order that the provider has written.)
0.5 mg
intravitreally OS (left eye)
every month, for 6 months
1. What is the Unit Dose for the drug being requested?
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg)
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg)
0.1
2. What dosage will be administered during each visit?
(This can be found in the provider order / dosing schedule. E.g. 0.5 mg intravitreally OS (left eye) every month, for 6 months)
(This can be found in the provider order / dosing schedule. E.g. 0.5 mg intravitreally OS (left eye) every month, for 6 months)
0.5
3. How many doses will be administered through the period being requested?
(This is determined from the provider order / dosing schedule. E.g. 0.5 mg intravitreally OS (left eye) every month, for 6 months. Since it is one eye, one time per month for 6 months, it would be 6 doses)
(This is determined from the provider order / dosing schedule. E.g. 0.5 mg intravitreally OS (left eye) every month, for 6 months. Since it is one eye, one time per month for 6 months, it would be 6 doses)
6
Total # Units to Be Requested
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
30
EXAMPLE 2
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg (Treating Both Eyes)
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg (Treating Both Eyes)
What is the HCPCS / CPT Code & Drug Name being requested?
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar,
0.1 mg
What is the dosing schedule?
(This is the order that the provider has written.)
(This is the order that the provider has written.)
0.5 mg
intravitreally OU (both eyes)
every month, for 6 months
1. What is the Unit Dose for the drug being requested?
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg)
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. Q5128 - Injection, ranibizumab-eqrn (Cimerli), biosimilar, 0.1 mg)
0.1
2. What dosage will be administered during each visit?
(This can be found in the provider order / dosing schedule. E.g. 0.5 mg intravitreally OU (both eyes) every month, for 6 months)
(This can be found in the provider order / dosing schedule. E.g. 0.5 mg intravitreally OU (both eyes) every month, for 6 months)
0.5
3. How many doses will be administered through the period being requested?
(This is determined from the provider order / dosing schedule. E.g. 0.5 mg intravitreally OU (both eyes) every month, for 6 months. Since it is both eyes, one time per month for 6 months, it would be 12 doses)
(This is determined from the provider order / dosing schedule. E.g. 0.5 mg intravitreally OU (both eyes) every month, for 6 months. Since it is both eyes, one time per month for 6 months, it would be 12 doses)
12
Total # Units to Be Requested
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
60
EXAMPLE 3
J1561 - Injection, immune globulin (Gamunex/Gamunex-C/Gammaked), nonlyophilized (liquid), 500 mg
J1561 - Injection, immune globulin (Gamunex/Gamunex-C/Gammaked), nonlyophilized (liquid), 500 mg
What is the HCPCS / CPT Code & Drug Name being requested?
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
(Full description can be found at the BSWHP Provider Portal or on the Codify by AAPC)
J1561 - Injection, immune globulin (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg
What is the dosing schedule?
(This is the order that the provider has written.)
(This is the order that the provider has written.)
80 g
(80,000 mg) IV q (every) 3 weeks,
6 doses total over 4 months
1. What is the Unit Dose for the drug being requested?
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. J1561 - Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg)
(This is the dose listed at the end of the full description of the HCPCS / CPT Code. E.g. J1561 - Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg)
500
2. What dosage will be administered during each visit?
(This can be found in the provider order / dosing schedule. E.g. 80 g (80,000 mg) IV q (every) 3 weeks, 6 doses total over 4 months. The units need to match the units used for the unit dose in number 2, therefore 80 grams would be converted to 80,000 milligrams.)
(This can be found in the provider order / dosing schedule. E.g. 80 g (80,000 mg) IV q (every) 3 weeks, 6 doses total over 4 months. The units need to match the units used for the unit dose in number 2, therefore 80 grams would be converted to 80,000 milligrams.)
80,000
3. How many doses will be administered through the period being requested?
(This is determined from the provider order / dosing schedule. E.g. 80 g (80,000 mg) IV q (every) 3 weeks, 6 doses total over 4 months.)
(This is determined from the provider order / dosing schedule. E.g. 80 g (80,000 mg) IV q (every) 3 weeks, 6 doses total over 4 months.)
6
Total # Units to Be Requested
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
(The tool calculates this based on the information you have filled in above and can be entered in the authorization request.)
960