What is the difference between HCPCS and NDC?
Asked by: Terence Koch | Last update: August 31, 2025Score: 4.9/5 (40 votes)
What is the crosswalk for NDC and HCPCS?
The NDC/HCPCS crosswalk file provides a list of National Drug Codes (NDC) that are assigned to a Level II HCPCS along with conversion factors that are used to price the applicable billings to allow processing of claims filed using the NCPDP format. View NDC Crosswalk Files: 2025 NDC/HCPCS Crosswalk.
What is the difference between a HCPCS and CPT code?
Some CPT codes are even used internationally. Medical providers often use these codes to describe and document the services they offer, in addition to using them for billing purposes. On the other hand, HCPCS codes are used to bill for a much smaller, more specific range of medical services.
What does NDC mean on a prescription?
Drugs are identified and reported using a unique, three-segment number called the National Drug Code (NDC) which serves as the FDA's identifier for drugs. FDA publishes the listed NDC numbers in the NDC Directory which is updated daily.
What is the difference between NDC and Hcpcs code?
NDC units are different from HCPCS code units. Use the HCPCS code and service units as you have in the past. This is the basis for your reimbursement. NDC units are based on the numeric quantity administered to the patient and the unit of measurement.
The Difference Between HCPCS and CPT Codes
What are the rules for NDC?
The CMS NDC identifier is formatted as 11 digits with no spaces, hyphens or other characters. If the NDC Package code is less than 11 digits (for example, a 4-4-2 structure) the code must be padded with leading zeros. The leading zero is added to the needed section to create a 5-4-2 configuration.
Is NDC 10 or 11 digits?
Proper billing of a National Drug Code (NDC) requires an 11-digit number in a 5-4-2 format. Converting National Drug Code (NDC) from a 10-digit to an 11-digit format requires a strategically placed zero, dependent upon the 10-digit format.
Why might a drug not have an NDC?
Why are some drug products not in the NDC Directory? There are a number of reasons why a drug product may not appear in the NDC Directory, such as: the product may not be a prescription drug, OTC, or an insulin product.
Does Medicare require NDC numbers?
To capture the information needed to fulfill the rebate requirements, Medicare providers billing for dual eligible patients will be required to submit the NDCs for physician-administered drugs.
When to use HCPCS?
HCPCS Level II: A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT® codes, such as ambulance services or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.
Is HCPCS only for Medicare?
Coders today use HCPCS codes to represent medical procedures to Medicare, Medicaid, and several other third-party payers. The code set is divided into three levels. Level one is identical to CPT, though technically those codes, when used to bill Medicare or Medicaid, are HCPCS codes.
Can CPT and HCPCS be billed together?
Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a Column One and Column Two HCPCS/CPT code. If a provider/supplier reports the 2 codes of an edit pair, the Column Two code is denied, and the Column One code is eligible for payment.
Do all J codes need NDC?
Professional and institutional primary and secondary claims submitted with drug-related (J or Q) codes must include the National Drug Code (NDC) number, quantity and unit of measure, in addition to the corresponding Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes and the ...
Which HCPCS code is also known as the national code?
HCPCS Level II is the national procedure code set for healthcare practitioners, providers, and medical equipment suppliers when filing health plan claims for medical devices, supplies, medications, transportation services, and other items and services.
What is an example of a NDC code?
Example NDC
For example, the NDC for a 100-count bottle of Prozac 20 mg is 0777-3105-02. The first segment of numbers identifies the labeler. In this case, the labeler code "00777" is for Dista Products Company, the labeler of Prozac.
What is NDC also called?
National Development Council (NDC) or the Rashtriya Vikas Parishad is the apex body for decision-making and deliberations on development matters in India presided over by the Prime Minister.
Can two drugs have the same NDC?
The NDC for a drug is a numeric code. Each finished drug product or unfinished drug subject to the listing requirements of this part must have a unique NDC to identify its labeler, product, and package size and type.
What does missing NDC mean?
If the NDC information is missing, invalid, incomplete, or does not match the HCPCS or CPT submitted, the claim may be denied. If the claim is denied, it can be resubmitted with the appropriate NDC information for reconsideration of reimbursement. Maximum Units per Package.
Do all drugs have NDC numbers?
The code is present on all nonprescription (OTC) and prescription medication packages and inserts in the US. The 3 segments of the NDC identify the labeler, the product, and the commercial package size. The first set of numbers in the NDC identifies the labeler (manufacturer, re-packager, or distributer).
Where to put zero in NDC number?
Happily, there's a simple set of rules to help place the zero in the correct location. For a 10 digit NDC in the 4-4-2 format, add a 0 in the 1st position. For a 10 digit NDC in the 5-3-2 format, add a 0 in the 6th position. For a 10 digit NDC in the 5-4-1 format, add a 0 in the 10th position.
How to bill NDC code on CMS 1500?
Where do I enter NDC data on a paper claim (CMS-1500)? In the shaded portion of line-item field 24A-24G, enter NDC qualifier N4 (left-justified), immediately followed by the NDC. Enter one space for separation. Next enter the appropriate qualifier for the correct dispensing NDC unit of measure (UN, ML, GR or F2).
What do the last 2 numbers of NDC mean?
The NDC is reported in an 11-digit format, which is divided into three sections. The first five digits indicate the manufacturer or the labeler; the next four digits indicate the ingredient, strength, dosage form and route of administration; and the last two digits indicate the packaging.
Which medication must have an imprint code?
All approved prescription and over-the-counter solid, oral dosage form medications in the U.S. are required by the Food and Drug Administration (FDA) to have an imprint. This also applies to biological drug products and homeopathic drug products, unless otherwise exempted in the FDA Code of Federal Regulations 206.7.
Why is NDC so important in pharmacy practice?
NDCs were designed for inventory management and reimbursement. Each product labeler assigns its own NDC for every product that it markets. So every distinct combination of brand name, dosage form, strength, and package size gets many different NDCs.