National Drug Code requirement on outpatient claims
For dates of service on and after December 11, 2020, all providers are required to supply the 11-digit NDC – along with the information below – when billing for injections and other drug items on the CMS-1500 and UB-04 claim forms as well as on 837 electronic transactions.
- The applicable HCPCS code or CPT code
- Number of HCPCS code or CPT code units
- The 11-digit NDC(s), including the N4 qualifier
- Dosage Unit of Measurement (F2, GR, ML, UN, ME)
- Number of NDC Units dispensed (must be greater than 0)
To ensure accurate and timely claims payments, it is important that you provide the NDC information as outlined above when filing claims to us. Empire will reject any line items on claims with dates of service on and after December 11, 2020, when the above information is not included regarding drugs.
If you have further questions, please contact the telephone number on the back of the member’s ID card.
October 2020 Empire Provider News