Claim Submissions with National Drug Codes (NDC)
10/12/2018
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Posted by Provider Relations
Claim submissions for physician-administered drugs require a valid 11-digit national drug code (NDC) number. Physician-administered drug claims submitted without a NDC number or with an invalid NDC number will be rejected.
This is a mandatory billing requirement that applies to all provider types and is in accordance with Section 6002 of the 2005 Federal Deficit Reduction Act (DRA). Claims must include the 11-digit NDC, in addition to the CPT/HCPCS code and number of units. The NDC dispensing quantity and the NDC unit of measurement are also mandatory. NDC information can be obtained from the drug invoice and/or package information. Additional billing information can be found by visiting eMedNY New York State Medicaid General Billing Guidelines Manual.