The instructions in this article are specific to entering the NDC on the UB-04 CMS-1450 claim form.

UB04 CMS-1450, Block 43, Description

Enter N4 (the NDC qualifier), the 11-digit NDC number, a space, and the unit of measurement code followed by the metric quantity or unit. Do not enter a space between the qualifier and the NDC number. 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.

Enter the NDC unit of measurement code and quantity or unit administered to the patient. If reporting a fraction of a unit, use a decimal point. The unit of measurement codes are:

·         F2—International unit.

·         GR—Gram.

·         ML—Milliliter.

·         UN—Unit.

Additional information about the Family Planning 2017 claim form, CMS-1500 professional claim form, and 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.