NDC billing requirements

Date: 12/15/16

Heritage Health (Medicaid):

All providers must submit NDC data, even if they hold 340b status.

CMS requires the 11-digit National Drug Code (NDC). Therefore, providers are required to submit claims with the exact NDC that appears on the actual product administered, which can be found on the vial of medication. The NDC must include the NDC Unit of Measure and NDC quantity/units.

When reporting a drug, enter identifier N4, the eleven-digit NDC code, unit qualifier, and number of units from the package of the dispensed drug.

If reporting a fraction of a unit, use the decimal point.  The unit quailfiers are: 

F2- internation unit

GR- gram

ML- mililiter

ME- miligram

UN- unit