Reporting NDC code for Unclassified drugs

Unclassified Drugs An unclassified drug is defined as a drug that does not have a specific, designated HCPCS/CPT code. Unclassified HCPCS/CPT codes should only be used when a specific HCPCS/CPT code is not available for the drug being billed. Claims being sumitted...

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...

DME Modifiers- AU, AV, AW, KM & KN

Payment of DMEPOS Items Based on Modifiers The following modifiers were added to the HCPCS to identify supplies and equipment that may be covered under more than one DMEPOS benefit category: • AU Item furnished in conjunction with a urological, ostomy, or tracheostomy...

how to use JW modifier

Effective July 1, 2016, providers are required to: • Use the JW modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP)...

Payment for service incident to Admission

Policy Services rendered prior to a related inpatient admission are considered incidental to admission and are included in the inpatient reimbursement rate. Services that are incidental to an admission include: • Surgical day care • Observation stay • Emergency room...