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September 2014
Insulin pumps can now be billed with National Drug Code
Effective Sept. 1, 2014, Blue Cross will allow DME providers that bill for insulin pumps (procedure code E0784) to report the National Drug Code in addition to the Healthcare Common Procedure Coding System code, known as HCPCS, for the item being supplied. Billing with the NDC eliminates the need to send in a copy of the manufacturer’s invoice and allows claims to be submitted electronically. However, you can continue to bill these claims with the manufacturer’s invoice as you do today.
The NDC is available on the packaging label or from the wholesaler.
Submitting the NDC on claims
Here are some general guidelines to assist you with proper submission of valid NDCs and related information on professional claims:
- The NDC must be submitted along with the applicable HCPCS code.
- The NDC must follow the “5digit4digit2digit” format (11 numeric characters with no spaces or special characters). If the NDC on the package label is fewer than 11 digits, you must add zeroes. See the chart below.
Convert National Drug Code from 10 to 11
Many National Drug Codes are displayed on drug packaging in a 10-digit format. Proper billing of an NDC requires an 11-digit number in a 5-4-2 format.
Converting NDCs requires an 11-digit number in a 5-4-2 format. Converting NDCs requires a strategically placed zero, depending on the 10-digit format. The following table shows common 10-digit NDC formats indicated on packaging and the appropriate conversion to an 11-digit format. The correctly formatted additional “0” is in bold and underlined in the following examples.
Note: Hyphens indicated below are used only to illustrate the various formatting examples for NDCs. Do not use hyphens when entering the NDC in your claim. |
10-digit format on package |
Example: 10-digit format on package |
11-digit format on package |
Example: 11-digit format on package |
4-4-2 |
0002-7597-01 |
5-4-2 |
00002-7597-01 |
5-3-2 |
50242-040-62 |
5-4-2 |
50242-0040-62 |
5-4-1 |
60575-4112-1 |
5-4-2 |
60575-4112-01 |
- The NDC must be active for the date of service.
- To submit electronic claims in the American National Standards Institute format (ANSI 837P format), report the following information:
Field name |
Field description |
ANSI (loop 2410) reference description |
Product ID Qualifier |
Enter “N4” in this field. |
LIN02 |
National Drug Code |
Enter the 11-digit NDC assigned to the insulin pump supplied. |
LIN03 |
National Drug Unit Count |
Enter the quantity (number of units) for the insulin pump. |
CTP04 |
Code Qualifier |
Enter the dispensing unit of measure of UN. |
CTP05-1 |
- To submit paper claims, enter the NDC information in field 24 of the CMS-1500 claim form. In the shaded portion of field 24A-24G, enter the qualifier “N4” left-justified, immediately followed by the national drug code. Next, enter the appropriate qualifier for the correct dispensing unit, followed by the quantity, as indicated in the example below.
The format for billing should be:
N4 + NDC code + three spaces + unit of measure + quantity
Example: N476300075115 UN1
Contact your provider consultant if you have any questions.
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