Saturday, August 28, 2010

where to enter NDC codes and required procedures

National Drug Code Required for Drug/Radiopharmaceutical Not Otherwise Classified Codes

The National Drug Code (NDC) number, name and dosage are required for all 'not otherwise classified' or 'unlisted' HCPCS procedure codes for drugs and radiopharmaceuticals (J3490, J3590, J9999, A4641, A9699 and A9700).
  • For electronic claims: submit this information in the electronic documentation record (2400-NTE, 02)
  • For paper claims: submit this information in Item 19 or an attachment to the CMS-1500 claim form
    • Note: The FDA standard is a 10 digit number, but to be compliant with the HIPAA standard of an 11 digit code, you may use a leading '0' to pad the number
  • Claims for unlisted drugs or radiopharmaceuticals that are submitted without this information will be returned as unprocessable and must be submitted as new claims
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download