Frequently Asked Questions: National Drug Code Requirements
This page provides answers to frequent asked questions about National Drug Code (NDC) requirements for physician-administered drugs when billing DMAP for fee-for-service clients.
If you have questions about NDC reporting for claims billed to DMAP, contact the DMAP Pharmacy Program. If you have questions about NDC reporting for claims billed to OHP managed care plans, contact the plan. OHP managed care plans with questions about NDC reporting should contact their DMAP Encounter Data Liaison.
Q: Why do I have to bill with National Drug Codes (NDCs) in addition to Healthcare Common Procedure Coding System (HCPCS) codes?
Q: What is the Drug Rebate Program?
Q: Which provider types are affected by this requirement?
Q: Who is included in "physician-administered drugs?
Q: Are hospitals required to submit the NDC?
Q: Which codes require NDC reporting?
Q: Do vaccines/immunizations require an NDC?
Q: Are Medicare crossover claims included in the NDC reporting requirements?
Q: Do I need to submit an NDC on claims that I purchased as 340B discounted prices?
NDC billing instructions
Q: How do I know if an NDC is rebateable?
Q: Where do I find information on specific HCPCS code billing information?
Q: What Revenue Code(s) must I use for billing hospital outpatient drugs?
Q: What is an NDC and how do I enter it on claims?
Q: Do I need to include units for both the HCPCS code and the NDC?
Q: Are the HCPCS code units different from the NDC units?
Q: If the physician administered a vial of medication to a patient, do I bill the NDC units in grams, milliliters, or units?
Q: How do I bill for a drug when only a partial vial was administered?
Q: How will NDC information be billed on electronic and paper claims forms?
Q: If NDC is not reported, will my claim deny?
Q: If the NDC is not rebatable or I am not sure which NDC was used, can I pick another NDC under the J-Code and bill with it?
Q: Our system does not accommodate a CPT/HCPCS for the Revenue Center Codes that now rquire one. Can we continue billing with these codes without a CPT/HCPCS?
Also review DMAP's recent announcements about NDC resources and NDC reminders, and the updated NDC Webinar.
DMAP provider guidelines:
Medicaid drug billing/reporting requirements: