Average Sale Price Payment Allowance Limit PartB Drugs April 2016

$79 / year

The ASP (Average Sale Price) crosswalks are maintained by the Division of Ambulatory Services to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs – National Drug Code) are assigned to which Healthcare Common Procedure Coding System (HCPCS) billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). This crosswalk is based on published drug and biological pricing data and information submitted to CMS (Centers for Medicare and Medicaid Services) by manufacturers. The information is intended to support ASP-based Medicare Part B payments only.

Complexity

The payment amounts that will be used to pay for Part B covered drugs for the second quarter of 2016 is represented here. CMS (Centers for Medicare and Medicaid Services) ensures continued beneficiary access to Part B covered drugs. It helps in monitoring trends in pricing, as reflected by the published ASP (Average Sale Price) payment rates, as well as utilization within the Medicare community. The quarter to quarter price changes are generally the result of updated data from the manufacturers of these drugs. The Medicare Part B payment limits for valid HCPCS codes that are not included in the quarterly ASP pricing files will be determined by the local Medicare contractor. CMS guidance requires physicians and other providers to bill using the appropriate Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy. Percentage of Vaccine AWP, Infusion AWP, Blood AWP Percent is 95 and Clotting Factor is 1 percent.

Date Created

2016-03-07

Last Modified

2016-03-01

Version

2016-03-01

Update Frequency

Quarterly

Temporal Coverage

2016-04-01 to 2016-06-30

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Cost Of Medicare, Price Prescription, Drug Schedules, ASP Crosswalks, Ambulatory Services to Support, Part B Drugs April 2016, HCPCS Crosswalk, NDC Packages

Other Titles

Average Sales Pricing Payment Allowance Limit for Part B Drugs, ASP Allowance Limit for Part B Drugs, Drug and Biological Pricing Data and Information

Name Description Type Constraints
HCPCS_CodeHealthcare Common Procedure Coding System, a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).stringrequired : 1
Short_DescriptionShort descriptor of the HCPCS codestringrequired : 1
HCPCS_Code_DosageThe dosage descriptor assigned to the HCPCS code (ex., 5 mcg.)stringrequired : 1
Payment_LimitPayment Limit Allowance Limit for Part B Drugsstring-
Vaccine_LimitVaccine Limit Allowance Limit for Part B Drugsstring-
DME_Infusion_LimitPayment for infusion drugs furnished through a covered item of DMEnumberlevel : Ratio
Blood_LimitBlood Limitnumberlevel : Ratio
NotesComments or Notes for the drug productstring-
HCPCS_CodeShort_DescriptionHCPCS_Code_DosagePayment_LimitVaccine_LimitDME_Infusion_LimitBlood_LimitNotes
J2185Meropenem100 MG1.37
J7185Xyntha inj1 IU1.198
J7189Factor viia1 MCG1.9
J0583Bivalirudin1 MG2.421
J3485Zidovudine10 MG1.501
J7190Factor viii1 IU0.964
Q4131Epifix1 SQ CM179.543
J1450Fluconazole200 MG5.03
J1640Hemin, 1 mg1 MG21.769
J8700Temozolomide5 MG3.575