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Reimbursement Codes provides access to all of our pricing, coding and clinical information. Our information can guide you to consistently define medical specialty drugs by cost, route of administration (injectable, infusion, oral, etc.) and therapeutic class.
The Pricing module includes 30-months of pricing information for each HCPCS/CPT® code. Pricing levels include AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), Medicare Allowable (ASP+6%), APC (Ambulatory Payment Classification), and CMAC (Customizable Maximum Allowable Cost). Customizable discounts can be applied to AWP, WAC, and ASP rates.
NDC Crosswalk module links each NDC to its appropriate HCPCS/CPT® drug code(s) based on the descriptor of the code. Each NDC includes NDC level pricing, billable units, status indicators for brand/generic, single dose/multi dose vial, active/inactive NDC status with corresponding effective dates, and CMS rebatable indication.
The NDC Conversion module converts HCPCS/CPT® drug code units to NDC units for NDC rebate initiatives and/or market share analysis, as well as NDC level reimbursement calculation. The NDC Conversion module converts HCPCS/CPT® drug code units to NDC units for NDC rebate initiatives and/or market share analysis, as well as NDC level reimbursement calculation.
Drug Diagnosis Coding 10
The Drug Diagnosis Coding 10 module provides FDA approved and Compendia listed ICD-10-CM indications for each HCPCS/CPT® drug code at Adult and Pediatric levels.
Min/Max Plus module provides minimum and maximum doses, including weight based ranges for adults and pediatric patients in units of the HCPCS/CPT® drug code.
Age/Gender module provides minimum and maximum ages for male and female patients for each HCPCS/CPT® drug code.
Administration Codes module provides appropriate administration code(s) based on the route(s) of administration for the drug for each HCPCS/CPT® drug code.
Part B or Part D
Part B or Part D module includes coverage within the Medicare Part B (Medical) or Part D (Pharmacy) benefits and guidance for when a product can be reimbursed under both benefit structures for each HCPCS/CPT® drug code.
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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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