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December 2016 Texas Medicaid Provider Procedures Manual

Appendix B: Vendor Drug Program : B.1 Vendor Drug Program : B.1.6 Clinician-Administered Drugs

B.1.6
All Texas Medicaid providers must submit a rebateable NDC for professional or outpatient claims submitted to TMHP with a clinician-administered drug procedure code.
The NDC is an 11-digit number on the package or container from which the medication is administered. Providers must enter identifier N4 before the NDC code. The NDC unit and the NDC unit of measure must be entered on all professional or outpatient claims that are submitted to TMHP and Medicaid managed care plans.
A list of drugs that require an NDC for Texas Medicaid reimbursement is available on the TMHP website at www.tmhp.com under the Topics section. Clinician-administered drugs that do not have a rebateable NDC will not be reimbursed by Texas Medicaid.
Refer to:

Texas Medicaid & Healthcare Partnership
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