CQW Panacea-re-brand-rev3


For the Week of October 20, 2014


How do I know whether to use the National Drug Code (NDC), the HCPCS, or another code set when reporting drugs and biologics on HIPAA transactions?


The final rule adopting changes to the HIPAA Electronic Transactions and Code Set standards published in the Federal Register on February 20, 2003, does not adopt a standard for reporting drugs and biologics in HIPAA transactions other than those for retail pharmacies.

Therefore, according to the Centers for Medicare & Medicaid Services (CMS), compliance permits the use of HCPCS codes or NDC to meet business needs. In the absence of an adopted code set for drugs and biologics, the X12 implementation guides adopted as HIPAA standards must be consulted. If you currently use HCPCS to report drugs and biologics you may continue to do so. You may also use the NDC code set if you meet the conditions for use specified in the implementation guide/TR3 report. The NDC code set must be used for reporting drugs and biologics on retail pharmacy transactions.

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