Although new requirements for
coding of physician-administered
drugs were enacted on
January 1, 69 percent of physician
claims have been denied, totaling
$2.5 million.
Physicians are now required to
include on their claims the drug’s
corresponding National Drug Code
(NDC). This code was required by the
federal Deficit Reduction Act, and it
applies to all Medicaid fee-for-service,
Primary Care Case Management
(PCCM), Family Planning, and
Children with Special Health Care
Needs (CSHCN) claims for physicianadministered
outpatient drugs with
drug procedure codes listed on the
Palmetto GBA “NDC to HCPCS
Crosswalk.” Drug claims submitted
with procedure codes in the “A” code
series will not require an NDC.
Drug claims requiring the NDC
can no longer be submitted through
TDHconnect.
Rejected claims can be paid on
appeal if the physician resubmits the
claims with the correct NDC, but to
avoid further denials, which cost time
and money, the Texas Medical
Association wants to remind physicians
of the guidelines for correctly
coding their claims.
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 three 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.
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