Others titles
- HCPCS Crosswalk for Cost of Medicare Part B Drugs October 2020
- HCPCS Crosswalk for Medicare Part B Drugs October 2020
Keywords
- Cost Of Medicare
- NDC Number
- Drug Prices
- ASP Crosswalks
- Ambulatory Services to Support
- Part B Drugs April 2019
- HCPCS Crosswalk
- NDC Packages
HCPCS Medicare Outpatient Prospective Payment PartB NDC
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.
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Description
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.
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 National Drug Code (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.
About this Dataset
Data Info
Date Created | 2016-03-07 |
---|---|
Last Modified | 2024-03-22 |
Version | 2024-03-22 |
Update Frequency |
Quarterly |
Temporal Coverage |
2024-04-01 |
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 Number, Drug Prices, ASP Crosswalks, Ambulatory Services to Support, Part B Drugs April 2019, HCPCS Crosswalk, NDC Packages |
Other Titles | HCPCS Crosswalk for Cost of Medicare Part B Drugs October 2020, HCPCS Crosswalk for Medicare Part B Drugs October 2020 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
HCPCS_Code | Healthcare Common Procedure Coding System, a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). | string | required : 1 |
Short_Description | Short description of the HCPCS code | string | required : 1 |
Labeler_Name | Manufacturer Name | string | required : 1 |
NDC | 11-Digit National Drug Code (NDC) or Alternate ID:typically xxxxx-xxxx-xx (dashes are included); alternate IDs vary in formatting | string | required : 1 |
Drug_Name | Product Name (brand or generic name may appear) | string | required : 1 |
Dosage | The dosage descriptor assigned to the HCPCS code (ex., 5 mcg.) | string | required : 1 |
Package_Size | The amount in one item. (For a product that is 100mcg/0.5 ml in one vial, the package size would be 0.5.) | string | required : 1 |
Package_Quantity | Number of items in the NDC (For an NDC that is 4 vials in a shelf pack, the package quantity would be 4.) | number | level : Ratiorequired : 1 |
Bill_Units | Billable 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.) | number | level : Ratiorequired : 1 |
Bill_Units_Package | Billable 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.) | number | level : Ratiorequired : 1 |
Data Preview
HCPCS Code | Short Description | Labeler Name | NDC | Drug Name | Dosage | Package Size | Package Quantity | Bill Units | Bill Units Package |
A9513 | Lutetium Lu 177 dotatat ther | ADVANCED ACCELERATOR APPLICATIONS | 69488-0003-01 | LUTATHERA | 1 MCI | 20 | 1 | 200 | 200 |
A9543 | Y90 ibritumomab, rx | SPECTRUM PHARMACEUTICALS | 68152-0103-03 | ZEVALIN Y-90 | UP TO 40 millicuries | 1 | 1 | 1 | 1 |
A9543 | Y90 ibritumomab, rx | ACROTECH BIOPHARMA | 72893-0007-04 | ZEVALIN Y-90 | UP TO 40 millicuries | 1 | 1 | 1 | 1 |
A9590 | Iodine i-131 therapeutic | PROGENICS PHARMACEUTICALS, INC. | 71258-0015-02 | AZEDRA dosimetric | 1Â mCi | 1 | 1 | 1 | 1 |
A9590 | Iodine i-131 therapeutic | PROGENICS PHARMACEUTICALS, INC. | 71258-0015-22 | AZEDRA therapeutic | 1Â mCi | 1 | 1 | 1 | 1 |
A9591 | Fluoroestradiol F 18 | ZIONEXA US CORPORATION | 72874-0001-01 | Cerianna | 1 mCi | 50 | 1 | 6 | 6 |
A9592 | Copper cu 64 dotatate diag | CURIUM US LLC | 69945-0064-01 | Detectnet | 1 mCi | 4 | 1 | 4 | 4 |
A9593 | Gallium ga-68 psma-11 ucsf | UCSF RADIOPHARMACEUTICAL FACILITY | 24275-0525-01 | Gallium Ga 68 PSMA (UCSF) | 1 mCi | 11 | 1 | 1 | 1 |
A9594 | Gallium ga-68 psma-11, ucla | UCLA BIOMEDICAL CYCLOTRON | 76394-2642-03 | Gallium Ga 68 PSMA (UCLA) | 1 mCi | 12 | 1 | 1 | 1 |
A9595 | Piflu f-18, dia 1 millicurie | PROGENICS PHARMACEUTICALS, INC | 71258-0022-00 | Pylarify | 1 millicurie | 1 | 1 | 9 | 9 |