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Effective January 1, 2015

 National Drug Code (NDC)

Providers may only be reimbursed for physician-administered drugs and biologicals whose manufacturers participate in the Centers for Medicare & Medicaid Services (CMS) Drug Rebate Program and that show as active on the CMS list for the date of service the drug is administered. All Medicaid (both fee-for-service and managed care), Children with Special Health Care Needs (CSHCN) Services Program, and Family Planning providers must submit an National Drug Code (NDC) for professional or outpatient claims submitted with clinician administered drug codes. The only exception is for vaccines, devices, and radiopharmaceuticals administered by a provider in outpatient settings. 

Provider types impacted by the NDC requirement include:

  • Primary care providers
  • Specialty care providers
  • Outpatient hospital departments
  • Federally qualified health centers
  • Rural health centers
  • All other outpatient providers administering drugs to patients

Texas Medicaid defines clinician-administered drugs as physician-administered drugs for procedure codes listed on the NDC-to-HCPCS Crosswalk.  

Beginning June 1, 2015, the NDC Unit of Measure and NDC Quantity fields will be required on claims for physician-administered drugs.

  •  Providers should submit the pharmacy unit of measure in the “NDC Unit of Measure” field on the claim, and use the value in Column J (“NDC Package Measure”) from the Texas NDC-to-HCPCS Crosswalk to report the Unit of Measure on the claim form.  Refer to the Texas NDC-to-HCPCS Crosswalk to convert the Healthcare Common Procedure Coding System (HCPCS) unit to NDC units.
  • Review the “HCPCS Description”, “NDC Label”, and “NDC Package Measure” columns of the NDC-to-HCPCS Crosswalk to calculate the NDC quantity.
  • Providers can refer to the VDP NDC Requirements for Clinician-Administered Drugs Provider Training for examples of NDC requirements on all claim types.

Providers can refer to the Texas Vendor Drug Program (VDP) website at for the Texas NDC-to-HCPCS Crosswalk, which identifies relationships between NDCs and HCPCS codes. The file is published at least quarterly.  

Physician-administered drugs that do not have an appropriate NDC to HCPCS combination for the procedure code that is submitted will not be reimbursed by the following programs:

  • Medicaid fee-for-service
  • CSHCN Services Program
  • Texas Women’s Health Program (TWHP)
  •  Medicaid Family Planning
  • The Expanded Primary Health Care (EPHC) Program
  •  Managed Care Organization (MCO) encounters for clinician-administered drugs.

 NDC Helpful Links

 NDC News Articles


Note: The information on this web page applies to claims submitted to TMHP for processing. For claims processed by a Medicaid managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, prior authorizations, and reimbursement.  

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