This policy describes the National Drug Code information that is required on professional and outpatient facility drug claims that are reported for reimbursement.
National Drug Code (NDC) numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size and quantity.
For purposes of this policy, a valid NDC number, NDC unit of measure and NDC units dispensed for the drug administered will be required for reimbursement of professional drug claims on a1500 Health Insurance Claim Form (a/k/a CMS-1500), the 837 professional transaction, a UB-04 Claim Form or the 837i facility transaction.
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Q: Do I have to bill the NDC information in addition to HCPCS, CPT or Revenue codes?
A: Yes, the NDC information must be submitted in addition to the applicable HCPCS, CPT or Revenue code(s) and the number of HCPCS, CPT or Revenue code units.
Q: Are the NDC units dispensed different from the HCPCS, CPT, and Revenue code units?
A: Yes. The units submitted for HCPCS, CPT, and Revenue codes are based on the HCPCS, CPT and Revenue code description. The NDC units dispensed are based upon the numeric quantity administered to the patient and the NDC unit of measure.
Q. 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?
A: The NDC required is from the vial that was administered to the member along with the appropriate NDC unit of measure and NDC quantity administered.