Instructions for completing the Metric Quantity fields (Boxes 13, 32, 51 and 70 as applicable).

• Enter the quantity of the entire amount dispensed and being billed on the claim.
• Quantities must be in metric decimal format.
• Do not include a decimal in either of the two boxes of the Metric Quantity field or the claim will be returned.
• The “Decimal” field must include trailing zeros, for a total of three digits.
• Do not use measurement units, such as “Gm” or “cc”.
• Entries should properly align within their intended fields.

Example 1: For a 2.5 Gm ointment, providers should enter “2” in the Whole Units box and “500” in the Decimal box.

Example 2: For three, 2.5 cc ampules, providers should enter “7” in the Whole Units box and “500” in the Decimal box (3 x 2.5 = 7.5).

Example 3: For an 8 cc ampule with no decimal numbers, providers are still required enter three zeros in the Decimal box.

If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.