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September 2015

Professional providers will get new message regarding National Drug Code daily quantity maximums

Starting as early as November, professional providers will receive a new message when a submitted NDC reaches or exceeds its recommended daily quantity maximum.

This maximum determines the number of billable units an NDC can be billed on a single claim line for a specific date. Currently, there is no NDC message when a daily maximum is reached or exceeded.

When a maximum quantity is reached, this message will alert professional providers that they only will be reimbursed for the daily maximum quantity. For example, if the maximum is five for the reported NDC, but a quantity of 15 is submitted, the message will state that there’s been an adjustment in the reimbursement. Payment will be made for the first five only.

We’ll provide additional details in The Record later this year.

The update doesn't apply to providers that don't submit claims using NDC.

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