National Drug Codes Required for All Physician-administered Medication

National Drug Codes (NDC) required for all physician-administered medication

In accordance with the New York State Medicaid Program, Independent Health requires a valid 11-digit NDC number on claims when billing for all physician-administered drugs that use J-codes for its state products (MediSource, Child Health Plus, Essential Plan). The New York State Medicaid Program most recently addressed this requirement in its April 2015 update (link below).

To participate properly in New York State’s All Payer Database, Independent Health is expanding this reporting requirement to all other fully-insured lines of business (Commercial plans and Medicare Managed Care plans) for dates of service beginning June 1, 2016.

The NDC is maintained by the U.S. Food and Drug Administration (FDA) and contains identifying information regarding the labeler/manufacturer, strength, dosage form and formulation of a drug product. The code is located on drug invoices, inserts and/or product packages.

Beginning for dates of service June 1, 2016, Independent Health will require the following when providers submit claims for physician-administered drugs that use J-codes (J0000-J9999):

  • Valid NDC number
  • Quantity and measurement

Please note, Independent Health will deny claims submitted without this information for dates of service June 1, 2016 or after.

The use of NDC codes follows similar efforts for improved specificity in health care operations, similar to the recent move to ICD-10 coding. 

Link to April 2015 Medicaid Update Addressing NDC Requirement
https://www.health.ny.gov/health_care/medicaid/program/update/2015/2015-04.htm#rep

Link to New York State All Payer Database Program
https://www.health.ny.gov/technology/all_payer_database

If you have questions, please contact Independent Health’s Provider Services Department at providerservice@servicing.independenthealth.com (preferred method) or call (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.