Earlier this year, physicians in at least 4 states received refund requests from Tricare administrative contractors in relation to payments for vaccine claims. The requests spanned multiple years and, in some cases, thousands of dollars in payments. The overpayments and, in some cases, underpayments were the result of claims processing based on the number of units per National Drug Code (NDC) rather than per Current Procedural Terminology (CPT®) code units. This highlights the need to recognize the difference in how units are reported and, perhaps more importantly, how payer systems interpret the number of units received on claims.

In many cases, the incorrect Tricare payments resulted from entry of 1.0 unit in the NDC units field for some vaccines that were provided in 0.5-mL doses. Because the contractor’s required unit of measure for the NDC units field is the number of milliliters for certain vaccine products, the...

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