National Drug Code (NDC) Claims Filing Tips

Version 14.8

Overview

The purpose of this article is to serve as a guide to users regarding the use of NDC Numbers (NDCs) and Units of Measurement (UOM) when billing medications administered in the office and vaccines as required on claims by most insurances. Before managing the tables that house this information, it is important to make sure that each payer that requires NDCs to be reported on claims is assigned as such in the Insurance Payer Setup. After making sure the payers are set up correctly, you will learn the correct NDC and UOM format and where medication and vaccine NDCs and UOM are pulled from.

Review Payer Setup

  1.  Navigate to Utilities > Manage Practice > Insurance Payers. The Insurance Payers List will open.
  2. Select your payer, and click the Edit Record button.
  3. In the lower section of the Basic Information tab, select the checkbox to 'Include NDC on vaccine products'. This will also include the NDC on medications administered in the office when coded.
  4. Click Save.

NDC Number Format

Each NDC Number must be reported as an 11-digit code unique to the manufacturer of the specific drug or product administered to the beneficiary using a 5-4-2 format (i.e. 5 digits, followed by 4 digits, followed by 2 digits [99999999999]). The chart below illustrates how to convert the 10-digit code into an 11-digit code based on the 10-digit number's format. The hyphens in the example below are for illustration only. If the NDC is not submitted in the correct format, the claim will be denied.

10-Digit Format on Package
10-Digit Format Example
11-Digit Format
11-Digit Format Example
4-4-2
9999-9999-995-4-209999-9999-99
5-3-299999-999-995-4-299999-0999-99
5-4-199999-9999-95-4-299999-9999-09

NDC Unit of Measurement Format

The standard reportable NDC Units of Measurement, as dictated by the National Uniform Claim Committee, NUCC, include:

  • F2: International Unit
  • GR: Gram
  • ME: Milligram
  • ML: Milliliter
  • UN: Unit

Medication NDCs and Units of Measurement

Medications, such as Albuterol, should be billed with the corresponding NDC number and Unit of Measurement. This information must be added to the CPT Code Table in order for the code to be billed properly. To add NDCs and Units of Measurement to medications:

  1. Navigate to Utilities > Manage Codes > Procedure (CPT) Codes. The CPT Code table will open.
  2. Search for and select the medication CPT code. 
Note: It may be useful to add any medication codes that your practice administers in the office to the Meds category. For more information on adding CPTs to respective categories, click here.
  1. Click the Edit record button.
  2. In the NDC ID field, enter the 11-digit NDC number and dose (Unit of Measurement). For example, 00487950125 UN1 where the format is:
  • 11-digit NDC Number
  • One space separating the NDC number and the unit/basis of measurement qualifier
  • Unit/basis of measurement qualifier
  • Quantity

NDC Quantity

The quantity of each NDC must be a numeric value greater than zero. In most cases, the NDC quantity will be different from the HCPCS billed units.

Vaccine NDCs and Units of Measurement

In order for NDCs and Units of Measurement to be billed for vaccines, the practice must be aware of its own status. The practice status determines where the NDC numbers and Units of Measurement are pulled from when vaccines are billed. The practice statuses are:

  • Practices that are fully live with OP: These are practices that are using OP 14 for Practice Management, Billing, and EHR.
  • Practices that are not fully live with OP: These are practices that are implementing OP 14 in a Split Go Live method. These practices Go Live with Practice Management and Billing first but are not yet live with EHR. 

Practices that are Fully Live with OP

Where NDC Pulls FromWhere Unit of Measure Pulls From
Vaccine Inventory: Activities > Maintain Vaccine InventoryVaccine Product Table: Utilities > Manage Codes > Vaccine Products
Note: UOM may also be added to the NDC ID field of the Vaccine Inventory window. For example, 00006404741 ML2. When UOM are added to this window, that entry will supersede the entry into the Vaccine Products table.

Practices that are not Fully Live with OP

Where NDC Pulls FromWhere Unit of Measure Pulls From
CPT Code Table: Utilities > Manage Practice > Procedure (CPT) CodesCPT Code Table: Utilities > Manage Practice > Procedure (CPT) Codes
Note: Once the practice goes live with the EHR side of OP, the Vaccine Inventory will be used. The NDC ID number will be entered for each vaccine lot. The NDC ID number in your Vaccine Inventory will supersede the CPT Code table when pulling the NDC onto the claim and the UOM in the Vaccine Products table will supersede the UOM attached to the CPT Code Table.


When posting charges, the UOM will not be visible in the Add/Edit Charges window. It will, however, be transmitted on the electronic claim and appear on a paper claim. If a payer requires something other than what is recorded in the Vaccine Products table or CPT Code table (according to practice status as mentioned above), then that required measurement must be added to the NDC Number field while claims are being posted. Any entry into the NDC field of the Add/Edit Charges window will supersede the information pulled from a table. If you need to edit the NDC Number field, be sure to follow this format: 
00006404741 ML2
where 00006404741 represents the 11-digit NDC Number and ML2 represents the Unit of Measure (milliliter in this example) and Quantity (2 in this example).

Billing Using the Electronic Claim Format

The following data elements should be used to submit the NDC Information in the HIPAA-standard ACS X12N8347 electronic claims format:

For Loop 2400

  • SV101 CPT/HCPCS code
  • SV104CPT/HCPCS units

For Loop 2410

  • LIN03 NDC (11-digit format)
  • CTP04 NDC Quantity
  • CTP05-1 NDC Unit or Basis for Measurement Code
Example - RotaTeq Rotavirus Vaccine
Loop
Segment
Value
CPT Code - 906802400SV10190680
CPT DUTS - 1-SV1041
NDC - 000064047412410LIN0300006404741
NDC Drug Quantity - 2-CPT042
NDC UOM - ML-CPT04-1ML

The complete 837 instructions are available in the HIPAA Implementation Guide on the Washington Publishing website at www.wpc-edi.com.

Billing Using the Paper Claim Form

If you bill on paper using the CMS-1500 form, use the shaded area of fields 24A-24G to report the NDC information in the following order:

  • Qualifier
  • 11-digit NDC Number
  • One space separating the NDC number and the unit/basis of measurement qualifier
  • Unit/basis of measurement qualifier
  • Quantity
Note: The number of digits for the quantity is limited to eight digits before the decimal and three digits after the decimal. If entering a whole number, do not use a decimal. If entering a unit less that one, do not include a zero. Do not use commas. Examples:
  • 1234.56
  • 2
  • 9999999.999
  • .5 (not 0.5 or .50)

See below for a claim example.

See the CMS-1500 Manual for additional information at www.nucc.org.