DME professional providers should report NDC quantity on medical drug claims

We previously told you that durable medical equipment providers soon would be subject to national drug code pricing for inhalation solutions. We ask that you submit matching HCPCS code and NDC information on your inhalation solution claims, starting July 1.

If you’re unable to report the NDC quantity at this time, we’ll assist you with the calculation until Nov. 1, 2014. If a medical drug claim doesn’t include the NDC quantity, we’ll use the HCPCS code and quantity in conjunction with a matching national drug code to calculate the NDC quantity. BCBSM will pay average wholesale prices based on that quantity, plus or minus the drug discount, as listed in the Injections or DME Fee Schedule.

BCBSM will pay the lowest or minimum fee listed in the Injections or DME Fee Schedule if claims are submitted with:

• No national drug code
• Invalid national drug codes
• NDC and HCPCS codes that don’t match

Claims submitted with not-otherwise-classified drug codes (J3490, for example) still require accurate NDCs and NDC quantities as they have in the past.

BCBSM will reinstitute the requirement to bill a matching and valid HCPCS and NDC code and quantity combination, along with the NDC unit of measures on medical drug claims, effective Nov. 1, 2014. BCBSM will no longer calculate the NDC quantity beginning on that date.

To recap, if the information is missing or invalid, we’ll reimburse the claim at the lowest average wholesale price or minimum fee, as described in this article.

For details about national drug code and unit of measure reporting, see the October 2013 issue of The Record.

For questions about the calculations, hard copy claims or other inquiries, contact your provider consultant. For questions about electronic 837 reporting requirement, call the e-BIG/EDI helpdesk at 1-800-542-0945.