Below are links to a downloadable list of drug-related HCPCS codes requiring an NDC. The list is
provided on both Adobe pdf and Microsoft Excel formats. The list reflects what was in effect at the
time of posting and is subject to change.
When a HCPCS code requires an NDC, EqualityCare will only cover those NDCs that are
rebateable per the Omnibus Budget Reconciliation Act of 1990. To simplify the identification of
rebateable NDCs, only HCPCS/NDC combinations with rebateable NDCs are shown. Providers are
encouraged to use the list to verify an NDC's rebate status prior to billing. NDCs that are not
rebateable will cause the respective institutional or professional line item to be denied.
The list of rebateable NDCs also gives providers a way to validate HCPCS/NDC combinations prior
to billing. Invalid HCPCS/NDC combinations will also be denied.
**Note: Medicare Crossover Claims**
Because EqualityCare pays Medicare coinsurance and deductible for dual-eligible clients, NDCs will
also be required on Medicare crossover claims for all applicable HCPCS codes on the list.
EqualityCare has verified that NDC information reported on claims submitted to Medicare will be
included in the automated crossover claim feed to EqualityCare.
The requirement will first be implemented for professional crossover claims. Beginning with dates of
service on and after March 1, 2008, professional crossover claim lines that are missing a required
NDC will be denied. The requirement for outpatient institutional crossover claims will be
implemented later in 2008.
HCPCS-NDC_Crosswalk_5/13/2009 (Adobe PDF)
HCPCS-NDC_Crosswalk_5/13/2009 (Microsoft Excel)
