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

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DrugReimbursement.com is an online-coding reference tool that delivers search capability on essential FDA-approved drugs and related medical codes (CPT® codes, HCPCS Level II and national drug codes), billing, coverage and reimbursement information. Its drug coding and reimbursement database is updated monthly, providing the most up-to-date reimbursement information available for HCPCS Level II codes and CPT® drug codes.
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Features and benefits

  • Customizable dashboard allows you to select and display key data elements.  Drill down to more detailed information in an easy-to-read grid format.
  • Provides a listing of applicable HCPCS Level II and CPT® codes with full descriptions are provided and 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 FDA approved drugs to CPT®/HCPCS codes, and current average wholesale price (AWP), current wholesale acquisition price (WAC) and Medicare Part B payment rates.
  • Simplify drug searches. Flexible search capabilities help you find drugs by CPT code, HCPCS Level II code, NDC, drug name (brand or generic), ICD-10/ICD-9-CM code, and by manufacturer.
  • Improve billing and chargemaster accuracy. Detailed drug data identifies packaging and billable units, related NDCs, strength, ingredients, therapeutic class and other details. Special icons alert you to new, revised or deleted codes and quantity issues.
  • Determine medical necessity and coverage under Medicare. Each CPT® code or HCPCS Level II code is linked to applicable national coverage determinations (NCDs) 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.
  • Monitor drug payment and AWP data. Current average wholesale package and unit pricing, Medicare Part B average sales price (ASP) and hospital APC/OPPS drug pricing information allows monitoring of drug charges, costs and expected Medicare reimbursement.
  • View up-to-date wholesale acquisition cost (WAC) data. Current WAC “list price” reference provides hospitals with reasonable reference pricing.
  • Drug data links to Medicare LCD policies, national coverage rules, and Pub. 100 references. Helps with billing compliance.

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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