Observation Stays No Longer Subject to Concurrent Review

NDC Requirements on HCPCS Codes for Medicaid Providers

Monday, December 15, 2014

Texas Medicaid participates in the Centers for Medicare & Medicaid Services (CMS) Drug Rebate Program. As a participant, Texas Medicaid reimburses providers only for clinician-administered drugs and biologicals whose manufacturers participate in the CMS Drug Rebate Program and who are active program members for the date of service a drug is administered. Texas Medicaid providers are required to include both (1) the NDC code and (2) the correlated Healthcare Common Procedure Coding System (HCPCS) procedure codes on their medical claims. Immunizations are not affected by this requirement.

Please refer to the Texas Vendor Drug Program’s (TX-VDP) quarterly updates for the rebate-eligible HHSC NDC to HCPCS Crosswalk list of clinician-administered drugs.
 
Physician-administered drugs that do not have a rebate-eligible NDC will not be reimbursed by Texas Medicaid. Please refer to the Texas Vendor Drug Program’s (TX-VDP) website for quarterly lists, updates, and additional information (including the rebate-eligible HHSC NDC to HCPCS Crosswalk list of clinician-administered drugs):  http://www.txvendordrug.com/formulary/clinician-administered-drugs.shtml.

If you have questions, please contact your Provider Relations Representative at 1-866-883-6654.

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