HCPCS Crosswalk Medicare Drug Price NOC NDC PartB Drug

$179 / 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 understand which drug products (identified by NDCs- National Drug Code) are assigned to which Healthcare Common Procedure Coding System (HCPCS) 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 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 (Healthcare Common Procedure Coding System) 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.

Date Created

2016-03-07

Last Modified

2020-02-13

Version

2020-02-13

Update Frequency

Quarterly

Temporal Coverage

2020

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

Cost Of Medicare, NDC Code, NDC Number, National Drug Code, ASP Crosswalks, Ambulatory Services to Support, Part B Drugs April 2020, HCPCS Crosswalk, NDC Packages

Other Titles

Payment Allowance Limits for Medicare Part B Not Otherwise Classified (NOC) Drugs, Not Otherwise Classified Part B Drug Payments, Drugs and Biological Data and Information

NameDescriptionTypeConstraints
Drug_Generic_NameGeneric name of drugstringrequired : 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.)numberlevel : Ratio required : 1
Package_QuantityNumber of items in the NDC (For an NDC that is 4 vials in a shelf pack, the package quantity would be 4.)numberlevel : Ratio required : 1
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.)numberlevel : Ratio required : 1
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.)numberlevel : Ratio required : 1
Drug Generic NameLabeler NameNDCDrug NameDosagePackage SizePackage QuantityBill UnitsBill Units Package
Alfentanil HclAkorn17478-0067-02ALFENTA500 MCG210220
Alfentanil HclAkorn17478-0067-05Alfenta500 MCG510550
Allopurinol SodiumWest-Ward Pharmaceuticals Corp00143-9533-01Allopurinol Sodium500 MG1111
Allopurinol SodiumMylan Institutional67457-0187-50Aloprim500 MG1111
Aminocaproic acidPfizer Inc.00409-4346-10Aminocaproic Acid250 MG202520500
Aminocaproic acidPfizer Inc.00409-4346-73AMINOCAPROIC ACID INJ250 MG202520500
AztreonamBristol-Myers Squibb Company00003-2230-11Azactam In Galaxy Container500 MG5024248
AztreonamBristol-Myers Squibb Company00003-2240-11Azactam In Galaxy Container500 MG5024496
AztreonamBristol-Myers Squibb Company00003-2560-16AZACTAM500 MG110220
AztreonamBristol-Myers Squibb Company00003-2570-16AZACTAM500 MG110440