Practitioner Administered Drug (PAD) Search Tool

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Procedure Code: J-Codes are part of the Healthcare Common Procedure Coding System (HCPCS) Level II set of procedure codes which designate practitioner administered drugs and other medical devices.

Crosswalked National Drug Code (NDC): The NDC serves as a universal product identifier for human drugs and biologics. The NDC/HCPCS crosswalk provides a list of NDC that are assigned to a Level II HCPCS. The NDC used must be submitted with each claim. Each NDC must be reported as an 11-digit code unique to the manufacturer of the specific drug or product. The 3 segments of the 11-digit NDC identify: The labeler (5-digit), the product (4-digit) and the commercial package size (2-digit). Search will yield partial results.

Drug Name: As it appears on the package label including strength dosage form and description.

Generic Name: The active ingredient of the drug product.

Procedure Manual Review Code:

• Not Required
• Required - Claims will pend for manual review. In some situation, clinical worksheets are required with the claim. Please see Practitioner Administered Drug Policies and Billing Guidance for a drug list and detail.
• Required Claim Charge Exceeds Price on File - Claims will pend when the amount charged exceeds the fee on file
• Required No Price on File - Claims will pend for procedure codes that do not have a fee on file ($0.00). These codes are typically listed in the fee schedule as by-report, "BR." All unlisted codes have this setting, as well as new procedure codes which don't have Federal Relative Values available and cannot be loaded with an established fee at the time of publication. Invoice costs are required for procedure codes with these values.

Category of Service (COS): The 4-digit number for the category of service assigned during enrollment. The description for the 4-digit number is also displayed.

Prior Authorization (PA) Required Code: Indicates if additional review is required for the procedure code

• Not Required - No PA required
• Required - Indicates a clinical worksheet is required with the claim. Please see Practitioner Administered Drug Policies and Billing Guidance for a drug list and detail.
• Billable Procedure Code For PAD Only - Indicates a clinical worksheet is required with the claim. Please see Practitioner Administered Drug Policies and Billing Guidance for a drug list and detail.

Procedure Name: The long description of the HCPCS Level II code.

Billing Unit Type: The unit of measure when billing NDC units. Provides the description of the corresponding valid units of measure per the NCPDP standard.

Drug Package Size: The total size of the package in volume or number of units contained.

HCPCS Code Dosage Description: The amount of product in a HCPCS billing unit (may be found in the HCPCS description)