The Record

Starting in August, Michigan outpatient facilities must bill NDCs with NOCs or commercial claims will reject

What you need to know

When outpatient facilities bill for drugs on an outpatient claim with a HCPCS code that has a not‑otherwise‑classified code, they must also include the NDC. This change begins on Aug. 1, 2021, and affects claims for commercial members.

Starting Aug. 1, 2021, we’re making changes to the way Michigan outpatient facilities bill some drugs. Drugs billed for a Blue Cross Blue Shield of Michigan commercial member on an outpatient claim with a HCPCS code that has a description indicating “miscellaneous ‑ not otherwise classified,” unlisted or non‑specified must also include the National Drug Code, or NDC.

HCPCS codes for not otherwise classified, or NOC, drugs billed without this information will be rejected and must be resubmitted with the missing information included.

Submitting NDCs on claims

The following is information on outpatient facility claims and general guidelines to assist you with proper submission of valid NDCs:

The NDC must be submitted along with the applicable drug NOC HCPCS codes.

Many NDCs 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 (11 numeric digits with no spaces or special characters). If the NDC on the package label has fewer than 11 digits, you must add a strategically placed zero. 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.

Hyphens below are used only to illustrate the various formatting examples for NDCs. Don’t 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 on the date of service.

To submit electronic claims (ANSI 837I), 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 drug supplied

LIN03

National Drug Unit Count

Enter the quantity (number of units)

CTP04

Code Qualifier

Enter the dispensing unit of measure

CTP05‑1

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 2020 American Medical Association. All rights reserved.