- Business Transformation
- Policies & Guidelines
Claims and Billing
- X12 Gateway Transition
- National Provider Identifier (NPI)
- Electronic Data Interchange (EDI) Services
- Claims Requirements and Communications
- Claims Submission Addresses
- Claims Requiring Submission of Clinical Information
- Chiropractic Billing Guide
- Clear Claim Connection and Significant Edits Disclosure Report
- Tools and Resources
- Pharmacy Information
- Resources for Patient Management
- Contact Us
NDC code submission changes effective January 1, 2009
We want to remind you of some changes to National Drug Code (NDC) submission that went into effect January 1, 2009, as part of our overall approach to managing specialty pharmaceutical benefits.
Please be advised that an edit is now in place to validate the NDC on any paper or electronic claims submitted with an unlisted and/or non-specific drug code. Please review the billing requirements listed below for your applicable provider type. By requesting this detailed drug billing information, we can provide greater transparency for our members and providers. Certain claims for unlisted and non-specific drug codes that are not accompanied by an NDC in the correct format and location will not be processed and will be returned to you for correction and resubmission. Please note that this requirement applies to all claims received after January 1, 2009 and is not based on date of service.
For professional providers: Effective January 1, 2009, claims for all unlisted and non-specific drug codes (CPT® or HCPCS) require submission of an NDC in the correct format and location. If the NDC is not submitted in the correct format or is missing, the claim will not be processed and will be returned to you for correction. The complete list of unlisted and non-specific codes that require the submission of an NDC can be found in the January 2009 Partners in Health Update.
For home infusion providers: Effective January 1, 2009, all drug claims (not just the unlisted and nonspecific CPT or HCPCS codes listed in the January 2009 Partners in Health Update) require the submission of an accompanying 11-digit NDC. This includes claims for hemophilia factor products that are currently submitted with specific J codes.
For institutional providers: Scheduled for future release in 2009, all claims for outpatient services containing the following pharmacy revenue codes and an unlisted and/or non-specific (CPT or HCPCS) code will require a valid NDC when submitted: 250-259, 262, 263, 331, 332, 335, 343, 344, and 631-637.
NDC Billing Information
Please submit the NDC using the 5-4-2 format when billing with hyphens (e.g., 12345-1234-12). NDC numbers without hyphens (e.g., 12345678911) will also be accepted. Please do not include spaces, decimals, or other characters in the 11-digit string or the claim will be returned for correction prior to processing.
Unlisted codes that will require submission of an NDC*
|90399||Unlisted immune globulin|
|A4641||Radiopharmaceutical, diagnostic, not otherwise classified|
|A9152||Single vitamin/mineral/trace element, oral, per dose, not otherwise specified|
|A9579||Injection, gadolinium based magnetic resonance contrast agent, not otherwise specified, per ml|
|A9698||Nonradioactive contrast imaging material, not otherwise classified, per study|
|A9699||Radiopharmaceutical, therapeutic, not otherwise classified|
|A9700||Supply of injectable contrast material for use in echocardiography, per study|
|C2698||Brachytherapy source, stranded, not otherwise specified, per source|
|C2699||Brachytherapy source, nonstranded, not otherwise specified, per source|
|C9399||Unclassified drugs or biologicals|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J3530||Nasal vaccine inhalation|
|J3535||Drug administered through a metered dose inhaler|
|J7199||Hemophilia clotting factor, not otherwise classified|
|J7599||Immunosuppressive drug, NOC|
|J7699||NOC drugs, inhalation solution administered through DME|
|J7799||NOC drugs, other than inhalation drugs, administered through DME|
|J8498||Antiemetic drug, rectal/suppository, not otherwise specified|
|J8499||Prescription drug, oral, nonchemotherapeutic, NOS|
|J8597||Antiemetic drug, oral, not otherwise specified|
|J8999||Prescription drug, oral, nonchemotherapeutic, NOS|
|J9999||NOC, antineoplastic drug|
|Q3001||Radioelements for brachytherapy, any type, each|
|Q4082||Drug or biological, not otherwise classified, Part B drug competitive acquisition program (CAP)|
|S5000||Prescription drug, generic|
|S5001||Prescription drug, brand name|
*These codes are subject to change pending routine updates.
Listing these codes on the table does not imply that a separate payment will be made for the code; that all current and future coding edits apply, and that these codes should only be reported when there is not a more specific code.
For information on claims submission resolution, please refer to the most recent Claims Preprocessing Edits Claims Resolution Document. If you have questions, please contact your Network Coordinator.