CQW Panacea-re-brand-rev3

Pharmacy

For the Week of July 28, 2014

Question:

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

Answer:

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, compliance permits the use of the HCPCS or NDC code set 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.

BMQ3APRM14 PHM

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