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Publisher: Optum360
Experts: Denise Smith
Sample Pages:  View PDF

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DrugReimbursement.com is an online drug coding and reimbursement reference tool and database that provides up-to-date Medicare coding, billing, and reimbursement information for FDA-approved drug codes. The detailed drug data, HCPCS Level II codes, and payment rates are provided in an easy-to-use, searchable format. Updating and tracking thousands of drug reimbursement codes has never been so easy. Updated monthly.
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Features and benefits

  • Customizable dashboard allows you to select and display key data elements and drill down to more detailed information in an easy-to-read grid format. 
  • Provides complete listing of HCPCS Level II and CPT® codes with full descriptions linked to NDC codes for billing drugs, biologicals, and vaccines under Medicare Part B (hospital and physician). The code and drug detail views make it easy to identify new codes, established codes, and not otherwise classified codes and their NDCs. 
  • Save research time. Provides complete, up-to-date crosswalk of approved national drug codes (NDCs) to CMS-billable drug codes under Part B and current AWP and Medicare Part B payment rates. 
  • Simplify drug searches. Flexible search capabilities help you find for drugs by CPT® code, HCPCS Level II code, NDC, drug name (brand or generic), ICD-9-CM/ICD-10 code, and by manufacturer. 
  • Improve billing and chargemaster accuracy. Detailed drug data identifies packaging and billable units, related NDCs, product packaging, strength, ingredients, therapeutic class, and other details. Special icons alert you to new, revised, or deleted codes and quality issues. 
  • Determine medical necessity and coverage under Medicare. Each CPT® code or HCPCS Level II code is linked to applicable national coverage policies and local coverage determinations (LCDs) to determine if the prescribed drug is covered under Medicare Part A or B. Additional links to Pub. 100 Part A/B guidelines, CMS transmittals, code-specific edits, and revenue codes help you differentiate physician and hospital drug billing criteria. 
  • Drug payment and AWP data. Current AWP package pricing and Medicare Part B ASP and hospital APC/OPPS drug pricing information help you monitor drug charges, costs, and expected Medicare reimbursement.
  • Wholesale Acquisition Cost (WAC) data. Current WAC/ manufacturer's "list price" provides hospitals with reasonable reference pricing. 
  • Drug data links to Medicare LCD policies, national coverage rules, and Pub. 100 references. Helps with billing compliance. 
  • Improve reimbursement for Part B drugs. Contains the latest Medicare allowable reimbursement, including current ASP and APC drug prices, to benchmark your expected Medicare reimbursement against actual payments received. 
  • Reduce denied claims. Provides crosswalks from HCPCS to NDC codes, generic and brand names, and packaging and unit variations for accurate billing

CPT is a registered trademark of the American Medical Association.


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Content Experts

Denise  Smith - Denise is the product manager for eFacility Solutions and has been with Optum360 for 24 years. During that time, she spent 10 years working closely with the chargemaster consulting team, and, prior to accepting her most recent position, was training as a junior consultant. She earned a Bachelor of Science degree in nursing from the University of Utah and is a certified coding professional.

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