Assessment of HCPCS Codes for Unapproved Products Leads to Corrected Linkages and New Manufacturer Strategy
Industry
Pharmaceutical Manufacturer
Problem
A manufacturer of 503(a) products wanted to determine the feasibility of obtaining HCPCS codes specific to their products. They were also concerned that the current HCPCS codes assigned to their products in Medi-Span may be inaccurate and asked PHSL to assist in correcting any inappropriate linkages.
PHSL Solutions
PHSL researched currently available HCPCS codes for the active ingredients present in the manufacturer’s products. PHSL then assessed HCPCS Code options for unfinished drug products and identified relevant sections of the “HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL II CODING PROCEDURES” to determine if there was a pathway to obtaining product specific HCPCS codes for the manufacturer. Finally, PHSL reviewed Medi-Span policies for HCPCS code linkages and drafted communications to request a change to the assigned HCPCS codes for the manufacturer’s products.
Results
PHSL communications with compendia were successful in removing the assigned HCPCS codes from the manufacturer’s NDCs. While research determined that the manufacturer’s products would not be eligible for new HCPCS codes, PHSL was able to educate the manufacturer on the assignment of HCPCS codes and discuss the currently available codes for their products. The manufacturer was then able to determine the best path to reimbursement using available HCPCS codes.