BOX 24D, how to put NDC CODE
Unshaded area: Enter the 5-digit CPT-4 or HCPCS procedure code that describes the procedure performed. If service provided requires modifier(s), enter up to 3 modifiers in the column(s) provided following the CPT-4 or HCPCS code. If more than 3 modifiers apply, enter modifier 99 first. Shaded area: Enter the NDC unit of measurement and numeric quantity administered to the patient. Enter the actual metric decimal quantity (units) administered to the patient. If reporting a fraction of a unit, use the decimal point. Nine numbers may precede the decimal point and three numbers may follow the decimal. The unit of measurement codes are: F2 -International Unit GR-Gram ML-Milliliter UN- Unit
24e Diagnosis Code Enter the diagnosis code reference numbers from form locator 21 (maximum 4). Only specific reference numbers (1, 2, 3, 4) will be accepted. Now its a, b, c, d
24f Charges Enter the total charge for the procedure performed.
24g Unit(s) Enter the number of times the procedure for which you are billing was performed. (Please note: decimal points are not allowed when billing CPT codes or HCPCS codes)
Unshaded area: Enter the 5-digit CPT-4 or HCPCS procedure code that describes the procedure performed. If service provided requires modifier(s), enter up to 3 modifiers in the column(s) provided following the CPT-4 or HCPCS code. If more than 3 modifiers apply, enter modifier 99 first. Shaded area: Enter the NDC unit of measurement and numeric quantity administered to the patient. Enter the actual metric decimal quantity (units) administered to the patient. If reporting a fraction of a unit, use the decimal point. Nine numbers may precede the decimal point and three numbers may follow the decimal. The unit of measurement codes are: F2 -International Unit GR-Gram ML-Milliliter UN- Unit
24e Diagnosis Code Enter the diagnosis code reference numbers from form locator 21 (maximum 4). Only specific reference numbers (1, 2, 3, 4) will be accepted. Now its a, b, c, d
24f Charges Enter the total charge for the procedure performed.
24g Unit(s) Enter the number of times the procedure for which you are billing was performed. (Please note: decimal points are not allowed when billing CPT codes or HCPCS codes)