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  Below is the transcript from our On-Demand Micro-Webinar: Where is my NDC? Powered by ReimbursementCodes.com Laura:  Welcome, and good day.  Thanks for joining us.  Today we would like to help you by answering the most frequently asked question about RJ Health Data; Where is my NDC? I’m Laura, Clinical Informatics  Pharmacists with RJ Health, and joining […]

INSIDE THIS ISSUE Code Updates: Large Price Changes New HCPCS® Codes and Changed Code Descriptions are Now Effective Code Strength Description Changes for New HCPCS® Codes CMS News: CMS Final Ruling on Medicare Physician Schedule Now Effective Quarterly ASP (Average Sales Price) Pricing File Released Hospital OPPS (Outpatient Prospective Payment System) Update Drug Reimbursement Code […]

In December there were a total of four new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were six supplemental drug approvals. The FDA had assigned eight new products for review. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include […]

There are several instances where dosing NDC and HCPCS code units don’t agree. Pay special attention when billing for a pediatric dose, that the NDC is billed under the pediatric code if one exists. Each dose has a different NDC unit, and they cross back to the single HCPCS value. If billed under the wrong […]

INSIDE THIS ISSUE Code Updates: Large Price Changes New HCPCS® Codes and Changed Code Descriptions Effective January 1, 2019 CMS News: CMS Final Ruling on Medicare Physician Schedule Effective January 1, 2019 Drug Reimbursement Code Price Updates: 47 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices: New Clinical and Billing Information CODE UPDATES Large […]

New Drug Overview – emapalumab-lzsg (Gamifant®) On November 20, 2018, the U.S. Food and Drug Administration (FDA) approved emapalumab-lzsg (Gamifant®) for the treatment of pediatric (newborn and above) and adult patients with primary hemophagocytic lymphohistiocytosis (HLH) who have refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. Primary HLH is an ultra-rare disease, […]

In November there were a total of eight new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were five supplemental drug approvals. The FDA had assigned five new products for review. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include […]

Whether the product comes in a single or multi-dose vile can also affect billing units. In this example, there is one billing unit contained in a single-dose vial, and 10 billing-units are contained in a multi-dose vial. In this case, it is helpful that the NDCs cross-walk back to different codes. Conversion factors are often incorporated […]

You have to take into account multiple considerations based on the NDC that is being billed, such as the dose for a pediatric patient billed differently from an adult dose, so each may crosswalk to a unique code. Whether the NDC designates a single dose or a multi-dose vile could affect the unit conversion.   […]