Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program may reimburse providers only for clinician-administered drugs and biologicals whose manufacturers participate in the Centers for Medicare and Medicaid Services (CMS) Drug Rebate Program and shows as active on the CMS list for the date of service the drug is administered. Clinician-administered drugs without a rebate-eligible National Drug Code (NDC) will not be reimbursed by Texas Medicaid or the CSHCN Services Program. There may be ingredients in a compound not considered a drug under the Federal Food, Drug, and Cosmetic Act.

The NDC-to-HCPCS Crosswalk identifies relationships between National Drug Codes (NDC) and Medicaid payable Healthcare Common Procedure Coding System (HCPCS) codes. The crosswalk is published quarterly and based on the additions to the CMS list of rebate-eligible drugs and any new drug added to First Databank.

The inclusion of a HCPCS code on the crosswalk does not guarantee coverage or payment. Refer to the Fee Schedule published by TMHP to insure the procedure is payable for the submitted program. The crosswalk assists providers with accurate claims submission, including the three NDC-related fields, required for Medicaid and CSHCN claims. Refer to the Clinician-Administered Drug Provider Training (PDF) for instructions on how to complete the claim.

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