NDC/HCPCS Crosswalk


Overview

The NDC/HCPCS Crosswalk, maintained by the PDAC, is a crucial resource file utilized by the claims payment system to accurately price drug claims that are submitted using the National Drug Codes (NDC) to the DME MACs. Applicable prescription drugs eligible for reimbursement under the DMEPOS benefit must be administered in a home setting and are limited to the following: 

  • Drugs administered via an external infusion pump.
  • Orally administered immunosuppressive drugs following a qualified transplant.
  • Intravenous Immune Globulin (IVIG).
  • Inhalation drugs administered via a pneumatic compressor, ultrasonic, or electronic nebulizer device.
  • Certain oral anticancer drugs (OACDs).
  • Oral antiemetic drugs administered as replacement for intravenous antiemetics.
  • HIV pre-exposure prophylaxis (PrEP)

Local Coverage Determinations (LCDs) and Policy Articles for these drug categories should be consulted to confirm coverage for specific drugs and other applicable coding scenarios.

Crosswalk File Details

The NDC/HCPCS crosswalk file provides a list of NDCs assigned to Level II HCPCS codes, including pricing conversion factors for billable claims submitted to the DME MACs. This allows for the processing of claims filed using the NCPDP format. 

The PDAC updates the crosswalk monthly to add, revise, or delete NDCs as published in the RED BOOK drug compendium. The prepared NDC/HCPCS Crosswalk files below outline these updates and changes. 

NDC/HCPCS Crosswalk Reference Files 

For NDC/HCPCS crosswalk file questions, view the NDC Crosswalk FAQs and Definitions page.

Important Notes

  • The NDC/HCPCS Crosswalk file does not represent a comprehensive listing of all drugs, drug names, and corresponding NDCs available in the United States that are eligible for billing to the DME MACs.
  • Apart from OACDs, the presence of an NDC in the crosswalk is not required for filing a drug claim to the DME MACs.
  • The presence or absence of an NDC listing does not indicate Medicare coverage or non-coverage of the related drug.

Additional Guidance

For guidance on the appropriate billing codes to use when filing prescription drug claims to insurers other than the DME MACs, contact:

  • Medicare Part A (e.g., inpatient hospital, skilled nursing facility (SNF), hospice)
  • Medicare Part B (e.g., outpatient hospital, physician’s office, freestanding clinic)
  • Medicare Part C Advantage
  • Medicare Part D (prescription drug benefit)
  • State Medicaid Agencies
  • Other Private Insurers