Effective for dates of service on or after January 1, 2008, all Medicaid fee-for-service, Primary Care Case Management (PCCM), Family Planning, and Children with Special Health Care Needs (CSHCN) Services Program providers that submit professional or outpatient claims with physician-administered prescription drug procedure codes listed on the Palmetto GBA “NDC to HCPCS Crosswalk” will be required to use the associated National Drug Code (NDC). Drug claims submitted with procedure codes in the “A” code series will not require an NDC.
The cross walk files are available here on the Palmetto GBA website.
Drug claims that require the NDC cannot be submitted through TDHconnect after January 1, 2008.
The revised Electronic Data Interchange (EDI) NDC compliant companion guides are available on the TMHP website as well as on TMHP EDI Testing site.
Listed below are specific instructions for entering the NDC on the UB-04, CMS-1500, and Family Planning 2017 claim forms:
UB-04—Box 43
Enter the NDC qualifier “N4” in the first two positions (left-justified) followed by the 11-digit NDC number. After the last digit of the NDC, enter the unit of measurement qualifier followed by the unit of quantity with a floating decimal for fractional units limited to 3 digits (to the right of the decimal). Any spaces that are not used for the quantity should be left blank. Do not enter hyphens or spaces within the NDC number. The NDC number submitted to Medicaid must be the NDC number on the package or container from which the medication was administered.
The unit of measurement codes are:
· F2—International Unit
· GR—Gram
· ML—Milliliter
· UN—Unit
CMS-1500—Box 24A (shaded upper line portion)
Shaded area: In Box 24A, enter the NDC qualifier “N4” followed by an 11-digit NDC number. Do not enter a space between the qualifier and the NDC. Do not enter a space, hyphen, or other separator between the qualifier and the qualifier/code information.
The NDC number submitted to Medicaid must be the actual NDC number on the package or container from which the medication was administered.
CMS-1500—Box 24D- Modifier (shaded upper line portion)
Shaded area: In Box 24D-Modifier, enter a 1- to 12-digit NDC unit of quantity (including any decimal point) or unit administered to the patient. If a fraction of a unit is reported, use a decimal point.
CMS-1500—Box 24G (shaded upper line portion)
Shaded area: In Box 24G, enter the NDC unit of measurement. The unit of measurement codes are:
· F2—International Unit
· GR—Gram
· ML—Milliliter
· UN—Unit
Note: The Family Planning 2017 paper claim form will be revised to have a shaded portion within each service detail line to accommodate the NDC implementation. The revised form will be published on www.tmhp.com by January 01, 2008.
FP2017—Box 32A (shaded upper line portion)
Shaded area: In Box 32A, enter the NDC qualifier “N4” followed by an 11-digit NDC number. Do not enter a space between the qualifier and the NDC. Do not enter a space, hyphen, or other separator between the qualifier and the qualifier/code information.
The NDC number submitted to Medicaid must be the actual NDC number on the package or container from which the medication was administered.
FP2017—Box 32D (shaded upper line portion)
Shaded area: In Box 32A, enter a 1- to 12-digit NDC unit of quantity (including any decimal point) or unit administered to the patient. If a fraction of a unit is reported, use a decimal point.
FP2017—Box 32F (shaded upper line portion)
Shaded area: In Box 32F, enter the NDC unit of measurement. The unit of measurement codes are:
· F2—International Unit
· GR—Gram
· ML—Milliliter
· UN—Unit
Additional information about NDC data will be published at a later date.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.