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Features
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Listing of all established HCPCS and CPT® drug related codes with corresponding descriptions. |
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Code Price (AWP/WAC-based calculation)
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Code Price customized per contractual agreement (i.e. Code Price - 15%)
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Medicare Allowable: Average Sales Price (ASP) + 6% (with quarterly updates)
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Ability to search by: |
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Drug/ Product Name (Brand or Generic)
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HCPCS or CPT® code
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NDC Number
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ICD-9-CM Code
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Therapeutic Class
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View Medicare Allowable history since 2003 |
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View Code Price (AWP) history since January 1, 2000 |
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View Code Price (WAC) history since August 1, 2005 |
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View NDC crosswalk by code for all NDCs which are billable under that code |
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Hospital Outpatient Billing Information (OPPS) |
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APC Codes
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Status Indicators
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Revenue Codes
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APC Rates
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View new and revised codes for the current year |
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View deleted codes since 2000 with references to newer codes if established |
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View drugs/products without an assigned code billable under a NOC (Not Otherwise Classified) code providing: |
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NDC - AWP/WAC pricing with history |
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Clinical information for the drugs/products
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Information on how to bill appropriately
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Search by ICD-9-CM to obtain related HCPCS/CPT® drug and product codes |
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View crosswalk of administrative codes related to each HCPCS/CPT® Drug and Product code |
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Reference the "How to Bill" section for sample CMS 1500 and Hospital UB-04 forms when: |
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There is no established Reimbursement Code for the drug;
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There is an established Reimbursement Code for the drug;
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The provider does not supply the drug;
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Providing Immunizations;
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Providing vaccines/toxoids or immune globulins which do not have an established CPT® drug code
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Benefits
ReimbursementCodes.com allows MCOs, Insurance Companies and Healthcare Professionals to accurately code and reimburse for drugs and products utilized in the physician's office, resulting in:
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More
rapid claims processing |
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Faster
reimbursement for services rendered |
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Fewer
rejected claims |
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Fewer
calls to physician offices |
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Improved
provider relations |
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More
accurate revenue forecasts |
The ReimbursementCodes.com website is an additional offering of the RJ Health Systems Drug Reimbursement Coding and Pricing Guide, a comprehensive, up-to-date, single source reference for the current pricing of the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT®) drug related codes.
Each Reimbursement Code is priced utilizing a validated methodology. Administrative charges which are billed separately are not included in the calculated price.
Code Price Calculation Methodology
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The following procedure has been adapted for every HCPCS and CPT® drug and product code that resides in the Reimbursement Code Database.
The Code Price for each drug code is determined from the published prices for the appropriate NDC (National Drug Code) number(s) utilizing the methodology outlined below. RJ Health Systems reviews each NDC number as to its availability nationwide, before including that NDC in the pricing calculation.
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Standard Code Price Calculation Criteria
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For a Single-Source drug or biological; the code price equals the NDC with the lowest AWP/WAC of the single source product corresponding to the description of the drug code
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For a Multi-Source drug or biological; the code price is equal to the lesser of the median AWP/WAC of all the generic forms of the drug or biological or the lowest NDC of the brand name product corresponding to the description of the drug code
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Median Code Price Calculation Criteria
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Pricing for certain codes are based on the median of all active (brand and generic) products which correspond to the description of the code
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Codes that are based on median code price calculation will be noted in the code descriptor
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Average Code Price Calculation Criteria
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Pricing for certain codes are based on an average of all active (brand and generic) products which correspond to the description of the code
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Codes that are based on average code price calculation will be noted in the code descriptor
Repackaged products are not included in any of the Code Price calculation methodologies
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Billable Units
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Billable Units - represents the number of units in a product based on strength of the product per vial/ampule/syringe, etc,
as it relates to the HCPCS or CPT® Drug Code description. For example:
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Code: J0290 Injection, ampicillin sodium, 500 mg
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Products:
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Injection, ampicillin sodium 500 mg / vial = 1.0 billable unit
Injection, ampicillin sodium 250 mg / vial = 0.50 billable unit
Injection, ampicillin sodium 125 mg / vial = 0.25 billable unit
Injection, ampicillin sodium 1 gm / vial = 2.0 billable units
Injection, ampicillin sodium 2 gm / vial = 4.0 billable units
Injection, ampicillin sodium 10 gm / vial = 20.0 billable units
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Billable Units per package - the number of units in the entire package, as it
relates to the HCPCS or CPT® drug code.
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Database Updates
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The ReimbursementCodes.com database is updated monthly. The Reimbursement Codes are updated at the close of business
on the last day of the month. |
Disclaimer:
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Code Price - The Code Price, for each Reimbursement Code, is determined from published prices utilizing a validated methodology |
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The Reimbursement Coding and Pricing Guide is to be used for informational purposes only. No liability is assumed with respect to accuracy of codes, prices or data herein, due to either clerical or typographical error. All prices shown, descriptions of Reimbursement Codes, and all other matters herein are subject to revision. Users of the Drug Reimbursement Coding and Pricing Guide should consult their legal advisor or health care consultant about claims to be filed for these products. No responsibility is assumed.
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