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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.3 Coding : 6.3.4 National Drug Code (NDC)

6.3.4
The NDC is an 11-digit number on the package or container from which the medication is administered. All Texas Medicaid fee-for-service 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:
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
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.
CMS-1500
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).
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.
Optional: In the shaded area, enter the NDC unit of measurement code.
Family Planning 2017
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).
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.
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 2011 American Medical Association. All rights reserved.