National Drug Code (NDC) requirements for drug claims

01/29/2021

Update Feb. 11, 2021: NDC requirments have been postponed until 2022.

 

Starting April 19, 2021, a valid National Drug Code (NDC) number, unit of measure, and units dispensed for drugs administered by health care professionals in ambulatory care settings will be required on all professional and facility drug claims.

 

Electronic and paper claims submitted with missing, invalid, or incomplete NDC information, or where NDC does not match the Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes submitted, will be denied. Claims can be resubmitted with the appropriate NDC information for reconsideration.

 

NDC numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size, and quantity. Including NDC information on claims will differentiate drugs that share the same HCPCS, CPT, or Revenue codes for drug preferences and enhance reimbursement processes.

 

For more information on NDC requirements including frequently asked questions, see the National Drug Code (NDC) Submissions Payment Policy.