TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Coding > National Drug Code (NDC)

   
 

6.3.4 National Drug Code (NDC)

The NDC is an 11-digit number on the package or container from which the medication is administered. All Texas Medicaid fee-for-service, PCCM, and Family Planning providers must submit an NDC for professional or outpatient claims submitted with physician-administered prescription drug procedure. Codes in the A code series do not require an NDC.

N4 must be entered before the NDC on claims.

The unit of measurement codes can also be submitted, however, are not required. The codes to be used for all claim forms are:

F2 - International unit

GR - Gram

ML - Milliliter

UN - Unit

Unit quantities can also be submitted, however, are not required.

Depending on the claim type, the NDC information must be submitted as indicated below for paper claims, or the equivalent electronic field:

UB-04 CMS 1450
Block No.
Description
Guidelines

43

Revenue codes and description

Enter N4 and the 11-digit NDC number (number on the package or container from which the medication was administered).

Optional: The unit of measurement code and the unit quantity with a floating decimal for fractional units (limited to 3 digits) can also be submitted, however, are not required.

Do not enter hyphens or spaces within this number.

Example: N400409231231GR0.025

CMS-1500
Block No.
Description
Guidelines

24A

Dates of service

In the shaded area, enter the NDC qualifier of N4 and the 11-digit NDC number (number on the package or container from which the medication was administered).

Do not enter hyphens or spaces within this number.

Example: N400409231231

24D

Procedures, services, or supplies

Optional: In the shaded area, enter a 1- through 12-digit NDC quantity of unit. A decimal point must be used for fractions of a unit.

24G

Days or units

Optional: In the shaded area, enter the NDC unit of measurement code.

Family Planning 2017
Block No.
Description
Guidelines

32A

Dates of service

In the shaded area, enter the NDC qualifier of N4 and the 11-digit NDC number (number on the package or container from which the medication was administered).

Do not enter hyphens or spaces within this number.

Example: N400409231231

32D

Procedures, services, or supplies CPT/HCPCS Modifier

Optional: In the shaded area, enter a 1-through 12-digit NDC quantity of unit. A decimal point must be used for fractions of a unit.

A decimal point must be used for fractions of a unit.

32F

Days or units

Optional: In the shaded area, enter the NDC unit of measurement code.

The Drugs Requiring NDC for Texas Medicaid Reimbursement list is available on the TMHP website at www.tmhp.com. The list contains those physician-administered, multiple-source drugs that the U.S. Secretary of Health and Human Services has determined to have the highest dollar volume of physician-administered drugs that are dispensed through Medicaid.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
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