With annual updates to billing codes for medications set for Jan. 1, physicians are reminded to use the most current National Drug Code (NDC) and Healthcare Common Procedure Coding System (HCPCS) combinations when filing claims for drug administration.
Each drug product is identified by a universal NDC and assigned an HCPCS billing code from databases that publish each year on Jan. 1.
Physicians can utilize resources like the NDC-to-HCPCS Crosswalk, which is available for clinician-administered drug processing. The Texas Health and Human Services Commission (HHSC) publishes the crosswalk, based on additions to the Centers for Medicare & Medicaid Services’ list of rebate-eligible drugs and new drugs. Clinicians can check the site each month for updates and are encouraged to reference the national database of NDC and HCPCS codes in the meantime.
When billing for administration of a drug, physicians must pull from the vial a specific NDC number that correlates with the payable HCPCS code in the national database. The crosswalk aids physicians in identifying those relationships between NDCs and HCPCS codes.
However, Texas Medical Association experts caution practices to make sure the NDC used is valid for the date of service. The effective date of the NDC must correlate with the date of service used on the claim. This is because NDCs can expire, change, or be prematurely removed from the national database. For instance, for a prescription administered prior to the Jan. 1 publication, use the prior NDC number. To ensure correct payment, the NDC code on the claim must correspond to that on the medication vial.
If you are receiving claims denials, contact TMA’s payment specialists for help.
Last Updated On
December 02, 2022
Originally Published On
December 02, 2022
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469