Types of Files
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 & Medicaid Services (CMS) Drug Rebate Program and that show as active on the CMS list for the date of service the drug is administered. Clinician-administered drugs that do not have a rebate-eligible National Drug Code (NDC) will not be reimbursed by Texas Medicaid or the CSHCN Services Program. Please note there may be ingredients in a compound that are not considered a drug under the Federal Food, Drug, and Cosmetic Act.
Texas Medicaid will published two types of files to our website:
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 monthly, based on quarterly additions to the CMS list of rebate-eligible drugs and new drugs that are added monthly to the First Data Bank pricing compendia.
- The inclusion of a HCPCS code on the crosswalk does not guarantee coverage or payment. Please refer to the Fee Schedule published by TMHP to insure the procedure is a payable for the submitted program.
- The crosswalk is intended to assist providers with accurate claims submission, including the three NDC-related fields, required for Medicaid and CSHCN claims. Please refer to the Clinician-Administered Drug Provider Training (PDF) for instructions on how to complete the claim.
- The Drug Labeler Directory identifies all labelers that participate in the CMS Drug Medicaid Rebate Program. The file is produced quarterly, about 45 days after the end of the calendar quarter.