NDC code submission
Pharmacy and medical claims for all unlisted and nonspecific drug codes (without a corollary CPT® or HCPCS code) require submission of a National Drug Code (NDC) in the correct format and location to properly adjudicate these claims consistent with our group benefits plans. If the NDC is not submitted in an 11-digit format or is missing, the claim will not be processed and will be returned to you for correction. The 11-digit format is 5-4-2 and is found on most drug packaging. This format serves a functional purpose: The first segment of the NDC identifies the labeler/manufacturer; the second segment identifies the product, strength, dosage form, and formulation; and the third segment identifies the package size of the drug.
For co-packaged products listed as kits and multi-level packaged products, providers should report the NDC on the OUTERMOST package. Only the outermost NDC is reported by firms as part of their product listing submission to the FDA and included in the NDC directory. Only NDCs included in the NDC directory will be considered valid NDCs for claims submission.
Note: Compound drugs should be reported with (1) an unlisted and/or nonspecific (CPT or HCPCS) code and (2) the NDC with the most expensive ingredient.
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 below.
Home infusion providers
All drug claims (not just the unlisted and nonspecific CPT or HCPCS codes listed below) require the submission of an accompanying 11-digit NDC. This includes claims for hemophilia factor products that are currently submitted with specific J codes.
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 NDC¹
|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|
¹These 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 claims resolution documents on the Trading Partner Business Center.
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