Billing > Billing

Billing based on AWP for a drug that has NDC to HCPCS crosswalk

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o.salas:
Hi all.

I have a doubt trying to bill a drug that has been priced based on AWP - 12% reference priced. Let say it's Alimta, HCPCS: J9305 500mg, Billing Unit: 50, NDC Unit: 1.

based on ASP price, we get ( price x unit x 50 ). How to calculate if based on AWP?.

Another example is there is no HCPCS crosswalk so no billing units available, should i use NDC unit to get the total price so (awp unit price x ndc unit)?

Michele:
I'm sorry but I have no experience with this.  I found this site that explains AWP pricing:

https://rjhealth.com/2019/07/31/drug-pricing-101-reimbursement-rj-health-methodologies-drug-claims-code-level-unit-level-hcpcs-ndc/

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