Skip to main content
 
Heading: Providers Topics
Texas MedicaidCSHCNFamily PlanningLong Term CareEDIMTPHealth ITTexas WHP

 

Effective January 1, 2015

 National Drug Code (NDC)

Providers can refer to the Texas Vendor Drug Program (VDP) website at http://www.txvendordrug.com/formulary/clinician-administered-drugs.shtml for the Texas NDC-to-HCPCS Crosswalk which identifies relationships between National Drug Codes (NDC) and Healthcare Common Procedure Coding System (HCPCS ) codes. The file is published at least quarterly.

Providers may  only be reimbursed for clinician-administered drugs and biologicals whose manufacturers participate in the Centers for Medicare & Medicaid Services (CMS) Drug Rebate Program and that show as active on the CMS list for the date of service the drug is administered

Physician-administered drugs that do not have an appropriate NDC to HCPCS combination for the procedure code that is submitted will not be reimbursed by the following programs:

  • Medicaid fee-for-service
  • Children with Special Health Care Needs (CSHCN) Services Program,
  • Texas Women’s Health Program (TWHP),
  • Medicaid Family Planning, the Expanded Primary Health Care (EPHC) Program, and
  • Managed Care Organization (MCO) encounters for clinician-administered drugs.

Claims submitted with these drugs must adhere to the TX NDC-to-HCPCS Crosswalk.

 NDC Helpful Links

 NDC News Articles

 

Note: The information on this web page applies to claims submitted to TMHP for processing. For claims processed by a Medicaid managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, prior authorizations, and reimbursement.  

   

Terms and Conditions | Contact Us | Help | Employment