How to report multiple NDC code - and format

Billing with National Drug Codes (NDCs)

Blue Cross and Blue Shield of Texas (BCBSTX) does not require inclusion of the National Drug Code (NDC) along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) code(s), except on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician-administered and physician-supplied home infusion therapy drugs.

BCBSTX currently accepts NDC for billing of all physician-administered and physician-supplied drugs in accordance with the NDC schedule posted on the BCBSTX Provider website under "Drugs".  Including the NDC on claims helps provide a more consistent pricing methodology for payment and will also facilitate better management of drug-associated costs. For information about how to add the additional NDC and other required elements, please refer to the BCBSTX Provider website at bcbstx.com/provider. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).

Claims should be submitted with the exact NDC that appears on the product administered.  The NDC is found on the medication’s packaging and must be submitted in the 5digit-4digit-2digit format.  

Please note:  A drug’s container label may display less than 11 NDC digits.  An asterisk may appear in either a product code or package code as a place holder for any leading zeros.  Zeros must be added to each section to make 11 digits total when submitting the NDC code on the claim to BCBSTX.   Decimal points are acceptable in the NDC unit field.  Each container label displays the appropriate unit of measure for that drug.

Please remember the following to help ensure proper submission of valid NDCs and related information: The NDC must be submitted along with the applicable HCPCS or CPT procedure code(s).

The NDC must be in the proper format (11 numeric characters, no spaces or special characters).
The NDC must be active for the date of service.
The appropriate qualifier, unit of measure, number of units, and price per unit also must be included, as indicated below.

BCBSTX utilizes a claims payment audit process (during initial claim payment and post payment) to validate the number of units administered against the submitted charges of medications. This audit process applies to claims for medications billed with Healthcare Common Procedure Coding System (HCPCS) codes, Current Procedural Terminology (CPT®) code(s), and National Drug Code (NDC).

The audit reviews claims to identify possible overbilling errors that exceed standard dosing thresholds. It may result in denying the portion of these claims that exceeds maximum dosing levels based on the product labeling, Food and Drug Administration (FDA) dosing guidelines; peer reviewed or published medical literature for each drug.

PAPER CLAIM GUIDELINES

In the shaded portion of the line-item field 24A-24G on the CMS-1500, enter the qualifier N4 (left- justified), immediately followed by the NDC.* Next, enter the appropriate qualifier for the correct dispensing unit (F2 – international unit mainly used for Factor VIII-Antihemophilic Factor; GR – gram, generally used for ointments, creams, inhaler or bulk powder in a jar; ML – milliliter, if drug comes in a vial in liquid form; UN – unit, if drug comes in a vial in powder form and has to be reconstituted; followed by the quantity and the price per unit, as indicated in the example below.

*Note: The HCPCS/CPT code corresponding to the NDC is entered in field 24D.

EXAMPLE NDC BILLING SCENARIO : To assist you with billing with NDCs, below is an example scenario.

What was administered?

In our sample scenario, a patient received Decitabine 50 mg.

What’s on the package label? 

The NDC is found on the medication’s packaging.  The drug’s container label may display less than 11 NDC digits.  An asterisk may appear in either a product code or package code as a place holder for any leading zeros.  Each container label displays the appropriate unit of measure for that drug.

Decitabine is supplied in a single-dose 50mg per vial.  Here is an example of the NDC information that you may see when you are preparing to bill: 62856-0600-01 Dacogen, 50mg SOLR Unit of Measure = UN

What to include on the claim: When entered on your claim, the NDC must follow the 5digit-4digit-2digit format, any leading zeros must be added to each segment to make 11 digits total.  The NDC must be in the proper format (11 numeric characters, no spaces or special characters).

For our example scenario:

The NDC is 62856-0600-01 (the qualifier is N4)
The unit of measure is UN, since the drug came in a single dose and does not specify the ML The quantity (number of NDC units administered) is 1
The quantity (number of J-code units administered) is 1

The HCPCS code is J0894

NDC Billing Instructions 

Molina EDI Help Desk reports that claims are being rejected because more than one NDC code is being billed on one service line.  Below you will find instructions on billing multiple NDC codes for the same drug on a claim.

For  more  detailed  information  on  billing  NDC  codes,  please  see  the  BMS  website  at
www.dhhr.wv.gov/bms under the heading “HCPCS/Drug Codes”.

NDC’s must be configured in what is referred to as a 542 format.  The first segment must include five digits, the second segment must include four digits, and the third segment must include 2 digits.  If an NDC is missing a number on the product label, the appropriate number of zeros must be added at the beginning of the segment.  Only the NDC as specified on the label of the product that is administered to the member is to be billed.  Every NDC must be billed with an N4 qualifier before the NDC with no hyphens or spaces, the unit qualifier such as F2 (International Unit), GR (Gram), ML (Milliliter), and UN (Unit) and the NDC quantity.  Billing instructions are available at www.dhhr.wv.gov/bms & Molina Medicaid Solutions at www.wvmmis.com. Important: All NDC charges must have the specific date of service the listed drug was adminis-tered and all NDC drug charges must be listed individually.

Important: All NDC charges must have the specific date of service the listed drug was adminis-tered and all NDC drug charges must be listed individually.

Multiple NDCs 

At times, it may be necessary for providers to report multiple NDCs for a single procedure code.  For codes that involve multiple NDCs (other than compounds, see BMS website), providers must bill the procedure code with KP modifier and the corresponding procedure code NDC qualifier, NDC, NDC unit qualifier, and NDC units.  The claim line must be billed with the charge for the amount of the drug dispensed for the NDC identified on the line.  The second line item with the same procedure code must be billed utilizing KQ modifier, the procedure code units, charge and NDC information for this portion of the drug.



How to convert a 10 digit NDC to 11 digits

NDC codes are traditionally segmented into three distinct digit groups. The first identifies the manufacturer or labeler of the drug in question. The second specifies the exact dosage and form. Finally, the third segment is used to identify the “package code” assigned by the labeler – whether a package contains 20 or 50 capsules, for example.

Converting 10-digit NDC numbers to the requisite 11 digits required for claim submission is a small matter of adding a well-placed zero to one of these three segments. But NDC numbers for different drugs follow different formats. There’s a simple set of rules to help place the zero in the correct location.

·         For a 10 digit NDC in the 4-4-2 format, add a 0 in the 1st position.
·         For a 10 digit NDC in the 5-3-2 format, add a 0 in the 6th position.
·         For a 10 digit NDC in the 5-4-1 format, add a 0 in the 10th position.

In table form, that looks like this:


10-Digit Format on Package  10-Digit Format Example 11-Digit Format  11-Digit Format Example

4-4-2 9999-9999-99   5-4-2 09999-9999-99

5-3-2 99999-999-99 5-4-2 99999-0999-99

5-4-1 99999-9999-9 5-4-2 99999-9999-09



Note that the resulting 11-digit NDC number to be used in the bill always follows a 5-4-2 pattern.

One more thing to remember: The hyphens in this table are used, only, to illustrate the segmentation inherent to the NDC format. When reporting a NDC on a claim form, NEVER use hyphens.


Billing with National Drug Codes

BCBSTX reimburses claims submitted with National Drug Code (NDC) in accordance with the NDC Fee Schedule posted on the BCBSTX provider website under "Drugs." To locate this information, click the Standards & Requirements tab, then select General Reimbursement Information, enter password, then scroll down to the Reimbursement Schedules and Related Information area, then go to Professional or Ancillary (as appropriate) and select the Blue Choice PPOSM and HMO Blue Texas Schedules offering, then select 2014 Schedules effective July 1, 2014, then select Drugs. The NDC Fee Schedule is updated monthly on the first of each month.

Lower-cost generic medications may be reimbursed with a larger margin compared to higher-cost generic and brand medications. Effective June 1, 2014, BCBSTX revised the methodology utilized for determining the allowables for Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®’) codes associated with multiple NDCs, including vaccines. The HCPCS or CPT code allowable generally will be equivalent to the lowest NDC allowable associated with the HCPCS or CPT code.

When drugs are billed under the medical benefit on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims, it is important to include NDCs and related data. Using NDCs on medical claims facilitates more accurate payment and better management of drug costs based on what was dispensed. Physicians and ancillary providers are encouraged to include NDC information on claims.

BCBSTX requires inclusion of the NDC along with the applicable HCPCS or CPT code(s) on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician or ancillary provider administered and supplied drugs. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).

As a reminder, when submitting NDCs on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims to BCBSTX, you must also include the following related information:

• The applicable HCPCS or CPT code
• Number of HCPCS/CPT units
• NDC qualifier (N4)

• NDC unit of measure (UN – Unit, ML – Milliliter, GR – Gram, F2 – International Unit)
• Number of NDC units (up to three decimal places)
• Your billable charge/price per unit

Attention electronic claim submitters: If you have converted to ANSI 5010, there should be no additional software requirements when NDCs are included on electronic claims. However, please verify with your software vendor to confirm that your Practice Management System accepts and transmits the NDC data fields appropriately. If you use a billing service or clearinghouse to submit electronic claims on your behalf, please check with them to ensure that NDC data is not manipulated or dropped inadvertently.


Prevnar Immunization 

Effective 12/30/2011 Prevnar 13® is available for WV Medicaid members over the age of 50. Prevnar 13® is FDA approved for adults 50+ years of age to help prevent pneumococcal pneu-monia, meningitis, and bacteremia caused by 13 strains of S pneumonia. CPT code 90670 is to be billed for adult vaccinations; the reimbursement includes the cost of administration – the im-munization administration codes are not to be billed separately for adult vaccines. Prevnar 13® is currently available for children up to the age of 6 through the Vaccines for Chil-dren (VFC) Program.  As with all VFC vaccines, bill the administration code with your charge for the service and the vaccine code with the SL modifier to indicate the vaccine was provided under
the VFC Program at no cost.

NDC on ub 04 - where to report

Placement of an NDC when filing a claim:

Paper:

If billing on a paper claim, an original Red & White form must be used - not a copy of an original.

 UB-04 location – Box 43 (Please refer to the NUBC for additional guidelines)

837 Institutional Outpatient – At the Service tab use the Rx Indicator field to switch from N to Y to bill with a NDC number. This will populate a Rx tab.

In the Rx tab there will be three fields: NDC number, Units (Unit Quantity), and Basis of measurement -(Unit of Measurement Qualifier).

Note: You will be able to input 10 NDCs per detail.

 CMS 1500 location – Box 24A (shaded area) (Please refer to NUCC for additional guidelines)

National Drug Code (NDC) Requirement - UB-04

In order to collect rebates from the correct manufacturers, VT Medicaid will require data elements at the detail level in addition to the HCPCS codes. These elements are the 11 digit National Drug Code (NDC) number, the Unit of Measurement Qualifier code, and the unit quantity. These must be reported on paper and electronic submissions of all outpatient claims.

The NDC billing requirement will apply to all details where HCPCS reporting is required.

Requirement on UB04 Form:

• Field 42: Revenue Code

• Field 43: NDC 11 digit number, Unit of Measurement Qualifier and Unit Quantity

• Field 44: HCPCS Code

42. Rev CD 43. Description 44. HCPCS/Rate 45. Serv.Date 46. Serv Units

636 [60126598741][UN][1111.234] HCPCS Code 07/01/2020 HPCPS Units

 11 Digit Unit of Unit

 NDC Measurement Quantity

 Qualifier

Unit of Measurement Qualifier

F2 – International Unit

GR – Gram

ML – Milliliter

UN – Unit

NDC code report formating CMS 1500 and electronic claim

NDC Reporting Guidelines

An NDC is required for pharmaceuticals that are dispensed from a pharmacy and physician-administered drugs in an office/clinic (i.e. FQHC/RHCs, dialysis facilities) or outpatient facility/hospital setting.

* Provider must submit the 11-digit National Drug Code (NDC), found on the vial of medication, associated with the administered drug.

* NDC codes should be reported according to the format set out by the National Drug Code Directory.

* NDC codes contain 3 segments each with a set number of characters.

* NDC codes MUST be billed with the N4 qualifier before the 11 digit NDC code, when billing on a paper claim

* N4 qualifier also applies to EDI claims. Include on EDI claim, open the loop for NDC in the Practice Management System and enter the 11 digit NDC code. The system will electronically insert the N4 qualifier in the correct location upon activating the loop.


Example:

N400056498000
Seg 1      Seg 2    Seg3
5 Digits 4 Digits 2 Digits
Labeler Product Size

NOTE: Segments are to run together with no spaces, dashes, or hyphens

Segment 1= Labeler Code; this segment will contain a 5 digit labeler code. Code should be preceded by 0’s (zeros) if the code does not equal 5 digits.

Example: Labeler Code is 56 then the segment entry would be 00056. (Padded with 3 zeros to complete the 5 digit label code)

Segment 2= Product Code; this segment will contain a 4 digit product code. The product code will always be 4 digits and will not require padding with zeros.

Segment 3= Trade Package Size; this segment will contain a 2 digit size code. The trade package size code will always be 2 digits and will not require padding with zeros.


Billing with National Drug Codes


•  Blue Cross and Blue Shield of Texas (BCBSTX) reimburses claims submitted with National Drug Codes (NDCs) in accordance with the NDC Fee Schedule posted on the BCBSTX provider website, bcbstx.com/provider, under "Drugs". The NDC Fee Schedule is updated monthly on the first of each month.

•  To locate this information:

** Click the Standards & Requirements tab, then select General Reimbursement Information,
** Enter password, then scroll down to the Reimbursement Schedules and Related

Information area, then go to Professional

** For Blue Choice PPO and HMO Blue Texas, select 2014 Schedules effective July 1, 2014, then scroll down to Drugs.
** For Blue Advantage HMO, select your county from the alphabetical links provided, select 2014 Schedules effective July 1, 2014, select the Specialty, then scroll down to Drugs

•  Lower-cost generic medications may be reimbursed with a larger margin compared to higher- cost generic and brand medications.

•  Effective June 1, 2014, BCBSTX revised the methodology utilized for determining the allowables for Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®,) codes associated with multiple NDCs. The HCPCS or CPT code allowable generally will be equivalent to the lowest NDC allowable associated with the HCPCS or CPT code.

•  When drugs are billed under the medical benefit on professional/ancillary electronic (ANSI
837P) and paper (CMS-1500) claims, it is important to include NDCs and related data. Using
NDCs on medical claims facilitates more accurate payment and better management of drug costs based on what was dispensed. Physicians and ancillary providers are encouraged to begin including the NDC information on claims as soon as possible.

•  BCBSTX requires inclusion of the NDC along with the applicable HCPCS or CPT code(s) on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician or ancillary provider administered and supplied drugs. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).

•  As a reminder, when submitting NDCs on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims to BCBSTX, you must also include the following related information:

** The applicable HCPCS or CPT code
** Number of HCPCS/CPT units
** NDC qualifier (N4)
** NDC unit of measure (UN – Unit, ML – Milliliter, GR – Gram, F2 – International Unit)
** Number of NDC units (up to three decimal places)
** Your billable charge/price per unit

•  If you submit claim electronically and you have converted to ANSI 5010, there should be no additional software requirements when NDCs are included on electronic claims. However, please verify with your software vendor to confirm that your Practice Management System accepts and transmits the NDC data fields appropriately. If you use a billing service or clearinghouse to submit electronic claims on your behalf, please check with them to ensure that NDC data is not manipulated or dropped inadvertently.

Billing with National Drug Codes (NDCs) Frequently Asked Questions

NDC Overview

1.   What is an NDC ?

“NDC” stands for National Drug Code. It is a unique, 3-segment numeric identifier assigned to each medication listed under Section 510 of the U.S. Federal Food, Drug and Cosmetic Act. The first segment  of the NDC identifies the labeler (i.e., the company that manufactures or distributes the drug). The second segment identifies the product (i.e., specific strength, dosage form, and formulation of a drug). The third segment identifies the package size and type. For billing purposes, the Centers for Medicare & Medicaid Services (CMS) created an 11-digit NDC derivative, which necessitates padding of the labeler (5 positions), product (4 positions) or package (2 positions) segment of the NDC with a leading zero, thus resulting in a fixed-length, 5-4-2 configuration. (See question 12 for details.)

2.   When should NDCs be entered on claims ?

Blue Cross and Blue Shield of Texas (BCBSTX) requests the use of NDCs and related information when drugs are billed on professional and ancillary electronic (ANSI 837P) and paper (CMS-1500) claims. Note:  BCBSTX requires inclusion of the NDC along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®’) code(s) on claim submissions for unlisted or ‘Not Otherwise Classified’ (NOC)  or ‘Not Otherwise Specified’ (NOS) physician administered and physician supplied drugs.

3.   Where do I find the NDC ?

The NDC is usually found on the drug label or outer packaging. The number on the packaging may be less than 11 digits. An asterisk may appear as a placeholder for any leading zeros. The label also displays information about the NDC unit of measure for that drug.

4.   If the medication comes in a box with multiple vials, should I use the NDC number on the box or the NDC number on the individual vial ?

If the medication comes in a box with multiple vials, using the NDC on the box (outer packaging) is recommended.

5.   Which NDC units of measure should I submit on BCBSTX claims to help ensure appropriate reimbursement ?

Listed below are the preferred NDC units of measure and their descriptions:
• UN (Unit) – Powder for injection (needs to be reconstituted), pellet, kit, patch, tablet, device
• ML (Milliliter) – Liquid, solution, or suspension
• GR (Gram) – Ointments, creams, inhalers or bulk powder in a jar
• F2 (International Unit) – Products described as IU/vial or micrograms

Note: ME is also a recognized billing qualifier that may be used to identify milligrams as the NDC unit of measure; however, drug costs are generally created at the UN or ML level. If a drug product is billed using milligrams, it is recommended that the milligrams be billed in an equivalent decimal format of grams (GR). BCBSTX allows up to three decimals in the NDC Units (quantity or number of units) field.

6.   What are the advantages of using NDCs ?

Using NDCs on medical claims helps facilitate more accurate payment and better management of drug costs based on what was administered and billed. To save administrative time and effort in reviewing denials and resubmissions, BCBSTX systematically verifies the 11-digit NDC, and appropriate use of NDC units and HCPCS/CPT units submitted by providers, unless the HCPCS or CPT code is a NOC or NOS code. Also, NDC pricing is normally updated on a monthly basis to reflect changes in drug cost.


Converting HCPCS/CPT Units to NDC Units

7.   What information do I need to have ready before converting HCPCS/CPT units to NDC units ?

Before you can fill out the claim to bill for a drug, you will need to know the following information:
• Amount of drug to be billed
• HCPCS/CPT code
• HCPCS/CPT code description
• Number of HCPCS/CPT units
• NDC (11-digit billing format)
• NDC description
• NDC unit of measure

Consider the following example for Ciprofloxacin IV 1200 MG (1 day supply):


8.   How do I calculate the NDC units ?

Billing the correct number of NDC units for the corresponding HCPCS/CPT codes on your claims is essential. There are two ways to calculate NDC units:

Option 1 – Use Our Online NDC Units Calculator Tool

BCBSTX contracted providers may access the online NDC Units Calculator Tool for assistance with converting HCPCS or CPT units to NDC units. This user friendly tool is available to BCBSTX contracted providers at no cost. (See question 9 for more details on how to access the online NDC Units Calculator Tool.)

Option 2 – Calculate the NDC Units Manually

If you prefer to calculate the NDC units manually, there are several steps you will need to take. Here is a sample manual calculation, using elements from question #7 [Ciprofloxacin IV, NDC 00409-4765- 86, 1200 MG (1 day supply)]:

• The amount of the drug to be billed is 1200 MG, which is equal to 6 HCPCS/CPT units.

• The NDC unit of measure for a liquid, solution or suspension is ML; therefore, the amount billed must be converted from MG to ML.

• According to the NDC description for NDC 00409-4765-86, there are 200 MG of ciprofloxacin in 20 ML of solution (200 MG/20 ML).

• Take the amount to be billed (1200 MG) divided by the number of MG in the NDC description (200 MG). 1200 ÷ 200 = 6

• Multiply the result (6) by the number of ML in the NDC description (20 ML) to arrive at the correct number of NDC units to be billed on the claim (120). 6 x 20 ML = 120

(Additional billing guidelines are included in the  Billing with National Drug Codes (NDCs) – Billing Guidelines for Professional Claims)

Submitting NDCs on Professional/Ancillary Claims

11. When submitting NDCs on my claim, what other information will I need to include ?

When submitting NDCs on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims, you must also include the following related information in order for your claim to be accepted and reviewed for possible benefits at the NDC level:

• The applicable HCPCS or CPT code
• Number of HCPCS/CPT units
• NDC qualifier (N4)
• NDC unit of measure (UN, ML, GR, F2)
• Number of NDC units (up to three decimal places

14. Are there any special software requirements to consider when NDCs are included on electronic claims ?

If you have converted to ANSI 5010, there should be no additional software requirements. Please verify with your software vendor to confirm that your Practice Management System accepts and transmits the NDC data fields appropriately. If you use a billing service or clearinghouse to submit electronic claims on your behalf, please check with them to ensure that NDC data is not manipulated or dropped inadvertently.

16. Can you give a billing example ?

HCPCS code J9400 provides a good billing example. A patient receives Ziv-Alfibercept ZALTRAP 400 MG. Zaltrap is available as 200 MG per 8 ML (25 MG per ML) solution, single-use vial, NDC 00024- 5841-01.

For this sample scenario:
• The NDC is 00024-5841-01 (the qualifier is N4)
• The unit of measure is ML
• The quantity (number of J-code units administered) is 400
• The quantity (number of NDC units administered) is 16

On the CMS-1500, the data would be entered as follows:  N400024584101 ML16

17. How many decimal places are allowed in the NDC units field* ?

BCBSTX allows up to three decimals in the NDC units (quantity or number of units) field. The more specific your claim is, the more accurate the reimbursement, if any, will be.

18. How do I determine if the NDC is valid for the date of service ?

When billing with NDCs on professional/ancillary electronic (837P) or paper (CMS-1500) claims, it is important to ensure that the NDC used is valid for the date of service. This is because NDCs can expire or change. An NDC’s inactive status is determined based on a drug’s market availability in nationally recognized drug information databases.

Additionally, an NDC is considered to be obsolete two years after its inactive date. It is a good idea to conduct a periodic check of records or automated systems where NDCs may be stored in your office for billing purposes. To help ensure that correct reimbursement is applied, the 11-digit NDC on your claim should correspond to the active NDC on the medication’s outer packaging. Inactive products will continue to be reimbursed until they become obsolete.

19. What if I do not include the NDC and/or related data ?

In accordance with Texas Administrative Code (28 TAC 21.2803), NDC is not a required data element. If NDC data is submitted appropriately, reimbursement will be based on the NDC, as posted on the BCBSTX Provider website at  bcbstx.com/provider. If the correct combination of both the HCPCS/CPT code and the NDC data is not submitted, reimbursement will be based on the appropriate HCPCS or CPT code reimbursement, as posted on the BCBSTX Provider website.

Reimbursement Details

20. How do I obtain NDC pricing information ?

The standard NDC Reimbursement Schedule is available in the Standards and Requirements/General Reimbursement Information section of the BCBSTX Provider website at  bcbstx.com/provider.


21. What if the reimbursement does not match the NDC allowable amount on the BCBSTX Reimbursement Schedule ?

First, review the NDC information you submitted. The NDC allowance on the NDC Reimbursement Schedule equals one NDC unit of measure. Reimbursement will be based on the actual ratio of HCPCS/CPT to NDC units of the product/service billed.

While some drugs may be administered as partial NDC units (i.e., 0.5 or 0.7), others may be 1 unit or multiple NDC units (i.e., 2 or 5). The correct NDC units billed (whether partial, single or multiple) should be used as the multiplier to determine the actual allowed amount.

where to enter NDC codes and required procedures

National Drug Code Required for Drug/Radiopharmaceutical Not Otherwise Classified Codes

The National Drug Code (NDC) number, name and dosage are required for all 'not otherwise classified' or 'unlisted' HCPCS procedure codes for drugs and radiopharmaceuticals (J3490, J3590, J9999, A4641, A9699 and A9700).

• For electronic claims: submit this information in the electronic documentation record (2400-NTE, 02)
• For paper claims: submit this information in Item 19 or an attachment to the CMS-1500 claim form
  
  • Note: The FDA standard is a 10 digit number, but to be compliant with the HIPAA standard of an 11 digit code, you may use a leading '0' to pad the number
• Claims for unlisted drugs or radiopharmaceuticals that are submitted without this information will be returned as unprocessable and must be submitted as new claims