National Drug Code (NDC) Claims Filing Tips

Where the NDC Number Pulls From

If your practice is live with OP, using the PM/Billing and EHR, the NDC ID number for vaccines will pull from the Vaccine Inventory for claims. If your practice will implement a Split Go-Live, meaning PM/Billing will be implemented first and choosing not to use the vaccine inventory in OP, you will need to add the NDC ID numbers for vaccines in the CPT Code table. Once the practice goes live with vaccine inventory 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 number onto the claim.

NDC Number Format

Each NDC 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]).

Some NDCs may be in a 10-digit format.  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.

10-Digit Format on Package
10-Digit Format Example
11-Digit Format
11-Digit Format Example
4-4-2
9999-9999-99
5-4-2
09999-999-99
5-3-2
99999-999-99
5-4-2
99999-0999-99
5-4-1
99999-9999-9
5-4-2
99999-9999-09

If the NDC is not submitted in the correct format, the claim will be denied.

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.

NDC Unit of Measurement

The unit of measurement (UOM) for each NDC may be required in claim submissions. This includes:

  • F2: International Unit
  • GR: Gram
  • ME: Milligram
  • ML: Milliliter
  • UN: Unit
Note: If an insurance payer requires that a unit of measure be reported for claim payment of a vaccine, it may be added to the NDC number in the Vaccine Inventory or CPT Code Table (depending on the go-live status of your practice). Adding the unit of measure to the vaccine's NDC number will report the unit of measure for that vaccine to all insurance payers. If all payers do not require this, then the NDC number and unit of measure should be manually added to the NDC number field while claims are being posted. The format should be entered as follows: 00006404741 ML2 (11 digit NDC number followed by unit of measure and quantity). 

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 - 90680
2400
SV101
90680
CPT DUTS - 1
-
SV104
1
NDC - 00006404741
2410
LIN03
00006404741
NDC Drug Quantity - 2
-
CPT04
2
NDC UOM - ML
-
CPT04-1
ML

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
  • NDC Number
  • One Space
  • Unit/basis of measurement qualifier
  • Quantity

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.

Billing Using XPress Claim

The image below is a sample image for billing using the XPress Claim.