Sunday, June 5, 2016

NDC to HCPCS Crosswalk List of codes


A critical component to filing claims with a NDC Code is to ensure that the appropriate HCPCS/CPT code is billed with the NDC Code. A NDC to HCPCS crosswalk identifies the assigned HCPCS/CPT code(s) for the NDC code associated to the drug service(s) billed based upon the information submitted and reported by the manufacture To ensure accurate appropriate billing of drug services, we use the crosswalk to determine whether the appropriate HCPCS/CPT code is billed for the submitted NDC code. All drug services must bill the assigned HCPCS/CPT code(s) associated to the drug’s NDC that was supplied/ administered based upon the drug form as supplied by the manufacture. In the instance a bulk powder is compounded, the NDC code applicable for the drug that was supplied by the manufacture as a bulk powder must be submitted; therefore, the HCPCS/CPT code billed must be applicable for the bulk powder and not associated to the form the drug was compounded into (i.e. pellet, injectable, tablet, etc.).

Below identifies multiple NDC to HCPCS Crosswalk examples:

HCPCS Drug Code      HCPCS Description    NDC Code    NDC Description(Brand Name)

 J2270     Injection, morphine sulfate, up to 10mg    00548-3391-10     Morphine Sulfate 1MG/ML SOLN

J3490       Unclassified drugs    51927-1000-00     Morphine Sulfate POWD

J3490       Unclassified drugs      54569-3260-00     Marcaine 0.25% SOLN

J1030   Injection, Methylprednisolone Acetate, 40 mg   00009-0280-03  Depo-Medrol 40 MG/ML SUSP

J1040    Injection, Methylprednisolone Acetate, 80 mg  00009-3475-03     Depo-Medrol 80 MG/ML SUSP

J0897   Injection, denosumab, 1 mg      55513-0710-01    Prolia 60 MG/ML SOLN

J0897     Injection, denosumab, 1 mg      55513-0730-01     Xgeva 120 MG/1.7ML SOLN

J2270     Injection, morphine sulfate, up to 10mg       00548-3391-10    Morphine Sulfate 1MG/ML SOLN

J3490       Unclassified drugs       51927-1000-00         Morphine Sulfate POWD

S0020     Injection, Bupivacaine Hydrochloride, 30 mL    54569-3260-00    Marcaine 0.25% SOLN

J3490    Unclassified drugs         54569-3260-00         Marcaine 0.25% SOLN

J1030     Injection, Methylprednisolone Acetate, 40 mg   00009-0280-03     Depo-Medrol 40 MG/ML SUSP

J1040    Injection, Methylprednisolone Acetate, 80 mg     00009-3475-03    Depo-Medrol 80 MG/ML SUSP

J0897     Injection, denosumab, 1 mg           55513-0710-01   Prolia 60 MG/ML SOLN

J0897      Injection, denosumab, 1 mg         55513-0730-01       Xgeva 120 MG/1.7ML SOLN

J7316     Injection, ocriplasmin, 0.125 mg      24856-0001-00        Jetrea 0.5MG/ 0.2ML SOLN

J3590      Unclassified biologics    24856-0001-00         Jetrea 0.5MG/ 0.2ML SOLN

J9999      Not otherwise classified, antineoplastic drugs     00085-1388-01     Sylatron 296 MCG KIT

J3490         Unclassified drugs      37803-0203-05         Baclofen POWD


*NOTE – Submitting a claim with a HCPCS/CPT code that does not align with the billed NDC code may result in a denial of payment.

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