An Orientation: Applicable Drug Data for ReimbursementCodes – Webinar Segment

RJ Health’s Saas provides data regarding the number of billable HCPCS code units that are associated with each NDC. Learn more:




Laura: First, we’d like to do a quick orientation to some of the applicable data. We will assume that you have some basic knowledge about medical claims, and we’ll focus on the location and use of popular pricing data. As a review, Chris will cover some basics.

Chris: Here at RJ Health, we focus on medically covered pharmaceuticals. These are typically products that are being billed underneath HCPCS or CPT Drug Codes. We also provide our users with an NDC Crosswalk, which links appropriate NDC’s to these individual HCPCS and CPT drug codes. We have a number of different pricing methodologies for our code level AWP, wholesale acquisition, the Medicare allowable published ASP, Vaccine, or Flat Rate, APC rates for outpatient hospital billing, as well as an internally developed CMAC or maximum allowable cost price. These are all done at the code level. In addition, we’ll also provide AWP and wholesale acquisition at the NDC level.

We will link the HCPCS code in the NDC, and provide you with the appropriate number of billable HCPCS code units that are associated with each NDC. As well as the NDC units, which are published as pricing units, typically in ML, TAB, or each. Package size, vial, ampule or syringe, or package quantity, which count for multiple vial, ampule or syringes.