National Drug Code (NDC) Billing Guidelines
Community First Health Plans (CFHP) requires the use of National Drug Codes (NDCs) and related information, such as Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT®) codes, when drugs are billed on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims.
This information may also be submitted on institutional/facility electronic (ANSI 837I) and paper (UB-04) claims. This includes drug-related revenue codes to report drug products used for services rendered at medical outpatient facilities as well as unlisted HCPCS/CPT codes that require additional NDC information.
All claims must first pass specific minimum edits prior to acceptance. Claim records that do not pass these minimum edits are invalid and will be rejected or denied. In order to avoid a rejection or denial please ensure claims are filed correctly.
What is an NDC and where do I find the NDC?
An NDC is a unique 11 digit, three segment number assigned to drugs by the drug manufacturer. An NDC has three segments: 1. Labeler: 5-digit code assigned by the Food and Drug Administration (FDA) and identifies the drug manufacturer. 2. Product: 4-digit code assigned by the drug manufacturer and identifies the specific product. 3. Package: 2-digit code assigned by the manufacturer and identifies the package size.
The NDC is usually found on the drug label or medication’s outer packaging. If the medication comes in a box with multiple vials, using the NDC on the box (outer packaging) is recommended. The container label also displays information for the unit of measure for the drug. Listed below are the NDC units of measure with examples.
- UN (Unit) – Powder-filled vials 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
How do I submit the NDC on my claim?
Here are some quick tips and general guidelines to assist you with proper submission of valid NDCs and related information on electronic and paper claims:
The NDC must be submitted along with the applicable HCPCS/CPT code(s) and the number of HCPCS/CPT billable units.
- The NDC must follow the 5digit4digit2digit format (11-digit billing format, with no spaces, hyphens or special characters). If the NDC on the package label is less than 11 digits, a leading zero must be added to the appropriate segment to create a 5-4-2 configuration.
- The NDC must be active for the date of service.
- Also include the NDC qualifier, number of NDC units and NDC unit of measure. As a reminder, you also must include your billable charge.