Select Medication List
Blue Cross and Blue Shield of Texas (BCBSTX) currently accepts NDC for billing of all physician or ancillary provider administered and supplied drugs. Effective Dec. 15, 2013, BCBSTX will begin reimbursing claims submitted with an NDC in accordance with the NDC Fee Schedule posted on the BCBSTX provider website, under "Drugs". The NDC Fee Schedule will be updated monthly on the first of the month, starting Jan. 1, 2014.
BCBSTX requires inclusion of the NDC along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®') code(s) on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician or ancillary provider administered and supplied drugs. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).
Making the transition to using NDCs on your claims may seem challenging, but it can also have its rewards.
- HCPCS/CPT codes used for billing medications under the medical benefit represent a broad therapeutic class or dose. The lack of specificity for HCPCS/CPT codes does not allow the identification of the specific product used. When you bill with NDCs in addition to including the appropriate HCPCS/CPT information, BCBSTX can identify and reimburse your office, in most instances, for the individual medication that was prescribed (instead of for a range of NDCs within HCPCS/CPT codes). Lower cost generic medications may be reimbursed with a larger margin compared to higher cost generic and brand medications.
- NDC pricing also paves the way for other initiatives, such as our new Select Medication List, which will be developed in stages to add specific drugs within particular classes or categories, based on safety and cost effectiveness. Currently, there are two medications on the Select Medication List – Synvisc-One®'' and Euflexxa®'''. These are injections from the viscosupplementation class and are used primarily for osteoarthritis knee pain relief.
We encourage physicians and their office staff to view the NDC Online Tutorial located on the BCBSTX provider website in the General Reimbursement Information section. Also, please refer to the Claims and Eligibility/Submitting Claimssection of our provider website to view the following:
Trademarks referenced above are the property of their respective owners.
The listing of any particular drug or classification of drugs is not a guarantee of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, terms, conditions, limitations and exclusions set forth in the member's policy or benefits document. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.
Synvisc-One is a registered trademark of Genzyme Corporation. Euflexxa is a registered trademark of Ferring Pharmaceuticals Inc. Genzyme Corporation and Ferring Pharmaceuticals are independent, third-party vendors and are solely responsible for the products and services they provide. The mention of a specific product or vendor is not an endorsement by BCBSTX, and BCBSTX makes no representations or endorsements regarding any of the vendors listed here. If you have any questions or concerns about the products or services they offer, you should contact the vendor(s) directly.