NDC/HCPCS Crosswalk FAQs and Definitions

Frequently Asked Questions

Contact the PDAC with questions not addressed below.

+ What is the conversion factor and how is it used?

When the DME MAC receives electronic claims in the NCPDP billing format, the conversion factor converts the NCPDP billing units to HCPCS billing units for Medicare claims processing. Example: An NDC has a strength of 50mg/ml and the NCPDP billing unit is “ML”. One NCPDP billing unit would contain 50mg. If the corresponding HCPCS unit is “per 10mg”, then one NCPDP billing unit would contain 5 HCPCS units. (50mg/ml divided by 10mg)

+ Can I still bill a drug to the DME MAC if it has been terminated on the NDC/HCPCS crosswalk?

You should contact the applicable DME MAC contractor with any billing concerns.

+ I don't see the NDC I am looking for on the NDC/HCPCS crosswalk. Can I request that it be added?

Before requesting the PDAC to add an NDC to the crosswalk you should confirm the following:

The drug in question is being administered in a home setting.
The drug is billable and eligible for reimbursement under a DMEPOS benefit category.

If applicable, and the provided NDC can be identified in the RED BOOK drug compendium, the PDAC will attempt to crosswalk the drug within a monthly update.

Understanding the Table Columns

NDC

The National Drug Code (NDC) serves as a universal product identifier for human drugs and biologics. Each NDC must be reported as an 11-digit code unique to the manufacturer of the specific drug or product.

NDC Mod

Healthcare Common Procedure Coding System (HCPCS) Level II codes may require the use of modifiers to capture the exact nature of the service, without altering the code’s definition. Level II modifiers can be numeric, alphabetic, or a combination of both, and are always two-characters long.

HCPCS

HCPCS codes are used by Medicare and monitored by CMS. HCPCS Level II codes are assigned to every service a medical practitioner provides to a Medicare patient including durable medical equipment, prosthetics, and orthotics supplies (DMEPOS). These codes are an alpha character followed by four numbers.

HCPCS Mod

HCPCS Level II codes may require the use of modifiers to capture the exact nature of the service. The Level II modifiers are two alphabetic or alphanumeric digits.

Relationship Start Date

The relationship start date between the NDC and HCPCS code. A new relationship start date is listed whenever any of the following occur:

New HCPCS code added
New NDC code added
NDC is reactivated
HCPCS code change description that adds a new NDC relationship for the HCPCS code

Relationship End Date

The relationship end date between the NDC and HCPCS code. A new relationship end date is listed whenever any of the following occur:

HCPCS Code Deletion
NDC Withdrawn
NDC deactivated

HCPCS Description

The long description of the HCPCS Level II code.

NDC Label

The following information may be present in this field:

Product name given to the product by the manufacturer
Additional information on product characteristics not captured in other fields may be provided
Details of packaging and preparation, such as “dialpak,” “fliptop vial,” “premixed,” and “micronized.” Flavors may be listed when applicable. Also shown, when appropriate, is information on package dimensions.
Example:“2 x 5 x 10”—and descriptive material such as “sulfite-free,” “refill,” and “non-drowsy.”
The product strength listed in alphabetical order of the active ingredients. For combination products, a hyphen may separate the individual strengths of the active ingredients.
Example: The strength of acetaminophen with codeine is expressed as “325 mg-30 mg.”

Number of Items in NDC Package

The amount of product contained in the package as defined by the billing unit standard of the National Council for Prescription Drug Programs (NCPDP).

NDC package Measure

The unit of measure (e.g., EA, ML, GM) for the NDC package.

NDC Package Type

The container or package used for the drug product, (e.g., vial, bottle, bag, etc.)

Route of Administration

Identifies the productÔÇÖs intake or application method.

NDC Billing Units

The unit of measure when billing NDC units. Provides the two-character abbreviation corresponding to valid units of measure per NCPDP standards. The only valid values for this field are “EA,” “GM,” or “ML.”

HCPCS Amount