What is “HCPCS”?
“HCPCS” means, Healthcare Common Procedure Coding Set. HCPCS describes the codes that physicians use to claim reimbursement for the procedures and drugs administered in the physician’s office for Medi-Cal reimbursement. These claims are for physician-administered injections that are part of the Fee for Service utilization, but were previously not invoiced because HCPCS codes were being used instead of NDCs. Invoices were mailed 2/4/98 retroactively for 4Q96 through 3Q97. They are typically paper and or batch claims and the HCPCS codes are not as detailed as NDCs. There are numerous drugs with HCPCS. However, rebates are only requested on those codes that are mapped to just one manufacturer/labeler and NDC. If a HCPCS product is mapped to two or more labelers the product is excluded from the invoice. The following document has a list of HCPCS X-Codes, and their corresponding drug and strength: http://files.medi-cal.ca.gov/pubsdoco/publications/masters-MTP/Part2/injectlist_m00o03o04o11.
“HCPCS” means, Healthcare Common Procedure Coding Set. HCPCS describes the codes that physicians use to claim reimbursement for the procedures and drugs administered in the physician’s office for Medi-Cal reimbursement. These claims are for physician-administered injections that are part of the Fee for Service utilization, but were previously not invoiced because HCPCS codes were being used instead of NDCs. Invoices were mailed 2/4/98 retroactively for 4Q96 through 3Q97. They are typically paper and or batch claims and the HCPCS codes are not as detailed as NDCs. There are numerous drugs with HCPCS. However, rebates are only requested on those codes that are mapped to just one manufacturer/labeler and NDC. If a HCPCS product is mapped to two or more labelers the product is excluded from the invoice.
Related Questions
- Do NDCs eliminate the need for providers to describe the drugs used with a HCPCS Level III code such as Z7610 (miscellaneous drugs) or a procedure code such as 90779 (therapeutic injection) in the Reserved for Local Use field (Box 19) on the CMS-1500 claim form?
- If a provider enters the HCPCS Level I, II or III code, units and/or NDC correctly, but does not enter the unit of measurement correctly, will that line item be denied?
- What HCPCS code(s) should be used to bill ABRAXANE?
