EUREKA! I think I've found it! From: /www.ghp.georgia.gov/wps/...rsswlk.pdf . This bulletin is 5/17/07.

Why are my claims continuing to deny against edit 1574—NDC Procedure Code Mismatch?

The system may not be recognizing the HCPCS/CPT NDC combination reported/billed as valid. Invalid HCPCS/CPT NDC combinations may be related to billing errors or crosswalk file set-up, i.e., the HCPCS code or NDC number may be a) incorrect, b) entered in the wrong field, c) missing the preceding N4 qualifier (where applicable), or d) not included on the NDC Crosswalk file. To determine if the claim denial is related to a correctable billing error or crosswalk file set-up, it is important to trouble shoot the issue:

Trouble Shooting Tips:

1. Verify the drug is covered by Georgia Medicaid—refer to the Physician Injectable Drug List at www.ghp.georgia.gov .
2. Check the HCPCS/CPT code to ensure it is valid, an approved code, and is being reported in a 5-digit alpha-numerical format
3. Check the NDC number to ensure it is being reported in an 11-digit numerical format. For NDC numbers with less than 11-digits, add “0” where indicated (refer to previous banner instructions).
4. Verify the N-4 qualifier is being reported with the NDC number on paper and X-14 electronically submitted claims only (refer to previous banner instructions)
5. Contact the Provider Inquiry Unit at (404) 298-1228 or toll free at (800) 766-4456 to verify the HCPCS code is on the crosswalk file.

If found to have been billing errors, correct and resubmit the claim.

If the response to all of the above is yes, it is possible the HCPCS/CPT NDC combination not be listed on the walk file. If the drug is already on the crosswalk file under a different HCPC/CPT code, the second HCPCS/CPT code cannot be added or processed. Namely because the crosswalk file entry process does not allow for more than one HCPCS/CPT code for the same drug to be mapped to the NDC number—resulting in claim denials.

For example, if CPT 90645 (HIB Vac, HBOC, IM) is already listed and mapped to NDC # 54569-5269-00—CPT 90647 (HIB Vac, PRP-OMP) cannot be added as it also maps to NDC 54569-5269-00. Other examples include but are not limited to:
a. 90633 (Hep A Vac, Ped/Adol, 2 dose) and 90634 (Hep A Vac Ped/Adol, 3 dose)share NDC 00006-4831-00
b. J0885 (Epoetin Alfa, 1000 units (for non-ESRD use)) and J0886 (Epoetin Alfa, 1000 units (for ESRD on dialysis)) share NDC 55513-0148-10

Sharon