About Us

Since 2000, ReimbursementCodes has been the industry’s go-to partner when it comes to reimbursing for Specialty Drugs against medical claims. Providers, payors and affiliated healthcare organizations rely on our platform with the coding and clinical data sets; to power workflow, drive accuracy into reimbursements and create a clear understanding for injectable drugs.

ReimbursementCodes is a software-as-a-service application and data platform that delivers a comprehensive crosswalk and conversion of HCPCS/CPT® codes to NDC codes. It includes unit conversions, calculators and workflow features to drive payment integrity for specialty drugs against the medical claim.

The data set accounts for validated pricing using AWP, WAC, ASP (Medicare Allowable), APC and CMAC for each HCPCS/CPT® code. It also includes ICD-10, Min and Max dosing (FDA and Compendia), as well as Age, Gender, Part B or D designation and the applicable Administrative codes. Our data is designed for direct integration with various healthcare systems, such as financial and analytic platforms, pharmacy operations, network contracting, and claims management.

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Methodology

We provide the longest-running, most trusted data specifically designed for managing medical drug spending. Our data is published monthly for systems and workflow integration by department, cross-functional operations or enterprise use.

We review, verify and update with data and inputs from multiple sources comprised of manufacturers, government agencies and publishing groups. Our reviews cover all aspects of coding, pricing and clinical assignments to be accounted for in our monthly updates. The data we publish online is the same data we publish for offline analysis as well as direct integration with department or enterprise systems.

Included with our monthly publishing:

  • HCPCS/CPT® Code and NDC Code Pricing
  • NDC Code Crosswalk to HCPCS/CPT®
  • NDC Unit Conversions
  • Dosing Limits (Min and Max)
  • Diagnosis (ICD10) Crosswalk

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ReimbursementCodes is the most trusted, comprehensive source of coding (HCPCS/CPT®, and NDC),
pricing (AWP, WAC, ASP, and CMAC) and clinical crosswalks (ICD10, Min/Max, and Age/Gender) to
accurately support reimbursement.

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