The Record - National drug code billing information required for medical drug claims

National drug code billing information required for medical drug claims

On Feb. 1, 2015, Blue Cross Blue Shield of Michigan will require the correct national drug code and national drug code quantity information to be submitted on medical drug claims. We’ll no longer calculate the NDC quantity of medical drugs as of this date. If the NDC and NDC quantity is not provided, the minimum fee schedule will apply.

Finding the NDC and unit of measure
The national drug code is found on a medication’s packaging. An asterisk may appear as a placeholder for any leading zeroes. The container label also displays the appropriate unit of measure for that drug. The unit of measure is by weight (grams: GR), volume (milliliter: ML) or count (unit: UN). Each dispensed dose must be converted into one of those units, following the manufacturer’s unit of measure. International units (F2) must be converted to standard measurements (GR, ML and UN).

For drugs that come in a vial in powder form that need to be reconstituted before administration, bill each vial (UN).

For drugs that comes in a vial in liquid form, bill in milliliters (ML).

For topical forms of medicine (e.g., cream, ointment and bulk powder in a jar), bill in grams (GR).

Note: We are not accepting milligrams (ME) as a unit of measure.

Submitting the NDC on claims
Here are some quick tips and general guidelines to help you with proper submission of valid NDCs and related information on professional claims:

The NDC must be submitted along with the applicable Healthcare Common Procedure Coding System or Current Procedural Terminology^® 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 leading zeroes to total 11 digits.

The NDC must be active for the date of service.

To submit electronic claims (ANSI 837P), report the following information:

Field name

Field description

(Loop 2410) – Ref Desc

Product ID Qualifier

Enter “N4” in this field.

LIN02

National Drug CD

Enter the 11-digit NDC assigned to the drug administered.

LIN03

NDC Units

Enter the quantity (number of units) for the prescription drug.

CTP04

NDC Unit / MEAS

Enter the unit of measure of the prescription drug given (GR, UN or ML).

CTP05-1

To submit paper claims, enter the NDC information in field 24 of the CMS-1500 claim. 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 (GR, UN or ML), followed by the quantity and the price per unit, as indicated in the example below.

The format for billing should be:
N4 + NDC code + 3 spaces + unit of measure + quantity
Example: N400173044202 ML2

Reimbursement for discarded drugs applies only to single use vials. Discarded amounts of drugs in multi-use vials are not eligible for payment.

For home infusion therapy, ambulatory infusion center, hemophilia network and specialty pharmacy, health care providers must continue to submit claims with national drug code and National Council for Prescription Drug Programs quantities electronically.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.