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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