NDC/HCPCS Crosswalk

With the drug spend on the medical benefit continuously rising, health plans are increasingly looking for innovative ways to save money and gather more detail on the drugs being dispensed. The NovoLogix NDC/HCPCS crosswalk technology effectively addresses both of these goals.

Presently, healthcare providers such as Physicians, Home Infusion Pharmacies and Specialty Pharmacies use approximately 1,200 different HCPCS codes to submit drug claims under a patient’s medical benefit. Typical subsets of HCPCS codes representing drugs include J-codes, Q-codes, S-codes and CPT codes. There are, however, 10 times more NDCs associated with the same drugs represented by the more general 1,200 HCPCS codes.

An individual J-code alone, such as J9045 for the oncology agent, carboplatin, has over 90 NDCs associated with it. Those NDCs represent 4 different package sizes and strengths, and more than 10 different pharmaceutical manufacturers. There are more NDCs than HCPCS codes because NDCs contain more detailed information, such as the drug’s name, along with its manufacturer, package size, strength and dosage form.

NovoLogix works with health plans to collect NDCs and seamlessly map these NDCs to the HCPCS codes in order to allow health plans to get the benefits of both coding sets via the NovoLogix software management platform. Utilizing this crosswalk allows health plans to:

• Apply a HCPCS-level fee schedule, such as an ASP-based, to NDCs
  
  
• Adjudicate claims based on a drug’s NDC, without having to update legacy systems to accommodate NDCs
  
  
• Create a NDC requirement to its provider network prior to submission of medical pharmacy transactions
  
  
• Pursue rebates and other partnership opportunities with pharmaceutical manufacturers based on more detailed data