Is NDC required on Medicare claims?

A1. While the Centers for Medicaid and Medicare Services (CMS) does not require the NDC on traditional Medicare claims, NJ Medicaid NDC requirements are being reviewed, communicated and enforced by the State of New Jersey.

What is Medicare NDC?

A National Drug Code (NDC) is a number that uniquely identifies your prescription medication, the drug manufacturer, the medication strength, and the packaging of your medication. However, Medicare (CMS) uses an 11-digit NDC and so do we.

What NDC format does CMS allow?

For billing purposes, the Centers for Medicare & Medicaid Services (CMS) created an 11-digit NDC derivative, which necessitates padding of the labeler (5 positions), product (4 positions) or package (2 positions) segment of the NDC with a leading zero, thus resulting in a fixed-length, 5-4-2 configuration.

What is the difference between HCPCS and NDC?

HCPCS is the set of procedure codes of health care. NDC is the product identifier that is used for the drugs intended for individual use.

Can a drug have multiple NDC codes?

Moving up to 6-digit labeler codes will expand NDCs to 11 digits and allows for two additional NDC configurations: 6-3-2 and 6-4-1, for a total of five possible NDC configurations (including the three 10-digit NDC configurations).

Do you use the NDC on the box or the vial?

The NDC is found on the prescription drug label of the container (e.g., vial, bottle, or tube). The NDC is a universal number that identifies a drug or a related drug item. The NDC number consists of 11 digits with hyphens separating the number into three segments in a 5-4-2 format (e.g., 12345-1234-12).

What is an organization determination?

An organization determination is any decision made by a Medicare health plan regarding: Authorization or payment for a health care item or service; The amount a health plan requires an enrollee to pay for an item or service; or. A limit on the quantity of items or services.

What does NDC not covered mean?

It’s a drug, but it is “unfinished” or “excluded”. NDC numbers in these files are considered to be “unapproved drugs” and therefore not covered by Medicare or other payers. These should not be billed to any payer unless there are specific coverage terms within the payer contract for unapproved drugs.

Does Cigna require NDC numbers?

Each drug code submitted must have a corresponding NDC, NDC unit, and NDC unit qualifier on each claim line….Frequently Asked Questions.

Why NDC code is required?

For certain purposes, including the proper billing of drug products, an 11-digit NDC may be required. The Centers for Medicare & Medicaid Services (CMS) and other government entities require an NDC as part of their billing claim form.

Which medication must have an imprint code?

All approved prescription and over-the-counter solid, oral dosage form medications in the U.S. are required by the Food and Drug Administration (FDA) to have an imprint. This also applies to biological drug products and homeopathic drug products, unless otherwise exempted in the FDA Code of Federal Regulations 206.7.