Margin analyzer

Expected Medicare Part B revenue for each drug, from the CMS payment limit and the billable units CMS assigns to each NDC package, compared with what you pay.

1 · Your items and costs

One line per item: an NDC with your cost per package, or a HCPCS code alone with your cost per billing unit. Add the HCPCS code to an NDC line when CMS crosswalks the NDC to more than one code.

Your costs never leave this browser. Only the codes and NDCs are sent to CodeRx to look up CMS payment limits and billable units.

Items

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Sequestration (% of Medicare’s share)

Count the patient’s coinsurance as collected (CMS file percentage — 20%, or less for drugs with an inflation-adjusted coinsurance)

No codes or NDCs recognized yet.

Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.