HCPCS Crosswalk Medicare Cost AWS Drug Code PartB Drug April 2016

$179 / year

The AWP (Average Wholesale Price) crosswalks are maintained by the Division of Ambulatory Services to support 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 – National Drug Code billing codes.

Complexity

The ASP (Average Sale Price) 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.

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 HCPCS or 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.

Date Created

2016-03-07

Last Modified

2016-03-07

Version

2016-03-07

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

Source License Requirements

N/A

Source Citation

N/A

Keywords

NDC Code, NDC Number, National Drug Code, Drug Prices, AWP Crosswalks, Ambulatory Services to Support, Part B Drugs April 2016, HCPCS Crosswalk, NDC Packages, ASP Crosswalks

Other Titles

Average Wholesale Pricing Payment Rates for Part B Drugs, Drug and Biological Pricing Data and Information, AWP Based Medicare Part B Payments

NameDescriptionTypeConstraints
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
Labeler_NameManufacturer Namestringrequired : 1
NDC11-Digit National Drug Code (NDC) or Alternate ID:typically xxxxx-xxxx-xx (dashes are included); alternate IDs vary in formattingstringrequired : 1
Drug_NameProduct Name (brand or generic name may appear)stringrequired : 1
DosageThe dosage descriptor assigned to the HCPCS code (ex., 5 mcg.)stringrequired : 1
Package_SizeThe amount in one item. (For a product that is 100mcg/0.5 ml in one vial, the package size would be 0.5.)numberrequired : 1 level : Ratio
Package_QuantityNumber of items in the NDC (For an NDC that is 4 vials in a shelf pack, the package quantity would be 4.)numberrequired : 1 level : Ratio
Bill_UnitsBillable Units Per 11-Digit NDC: the number of billable units per NDC (20 billable units in each item multiplied by 4 vials in the NDC shelf pack (aka the package quantity) = 80 billable units per NDC.)numberrequired : 1 level : Ratio
Bill_Units_PackageBillable Units Per Package: the number of billable units per package (100 mcg in a package divided by 5 mcg in the dosage descriptor = 20 billable units per package.)numberrequired : 1 level : Ratio
HCPCS_CodeShort_DescriptionLabeler_NameNDCDrug_NameDosagePackage_SizePackage_QuantityBill_UnitsBill_Units_Package
J7185Xyntha injPFIZER INC.58394-0012-01XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0013-01XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0014-01XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0015-01XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0016-03XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0022-03XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0023-03XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0024-03XYNTHA1 IU1111
J7185Xyntha injPFIZER INC.58394-0025-03XYNTHA1 IU1111
J8510Oral busulfanAspen76388-0713-25Myleran2 MG125125