HCPCS Medicare Outpatient Prospective Payment PartB NDC 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 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 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.

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

Other Titles

HCPCS Crosswalk for Cost of Medicare Part B Drugs April 2016, HCPCS Crosswalk for Medicare Part B Drugs April 2016

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_DescriptorShort descriptor of the HCPCS codestringrequired : 1
Labeler_NameManufacturer Namestringrequired : 1
NDC_or_Alternate_ID11-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_DescriptorLabeler_NameNDC_or_Alternate_IDDrug_NameDosagePackage_SizePackage_QuantityBill_UnitsBill_Units_Package
C9132Kcentra, per i.u.CSL BEHRING LLC63833-0387-02Kcentra1 IU1111
C9132Kcentra, per i.u.CSL Behring GmbH63833-0386-02Kcentra1 IU1111
A9606Radium Ra223 dichloride therBayer50419-0208-01 Xofigo1 mCi6111
C9121Injection, argatrobanSandoz Inc00781-3285-12ARGATROBAN5MG12522550
A9600Sr89 strontiumGE Healthcare17156-0524-01METASTRONPER MILLICURIE4144
C9121Injection, argatrobanSandoz Inc00781-3314-95ARGATROBAN5 MG501010100
C9121Injection, argatrobanSandoz Inc00781-9314-95ARGATROBAN5 MG501010100
C9473Injection, mepolizumabGlaxoSmithkline00173-0881-01NUCALA1 MG11100100
C9138Nuwiq Factor VIII recombOCTAPHARMA USA, INC.68982-0139-01NUWIQ1 IU1111
C9138Nuwiq Factor VIII recombOCTAPHARMA USA, INC.68982-0141-01NUWIQ1 IU1111