Medication Authorization List for Independent Duty ...
When the amount for this charge exceeds $50, attach a list of medications, include the name of the drugs, quantities dispensed, dosage prescribed and charges per prescription. For Medicare claims only, take-home drugs must be billed using the non-contract inpatient provider number. 2 – Ancillary Codes Inpatient Services 393. June 2007. ancil ... ................
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