Reporting the National Drug Code

Reporting National Drug Code (NDC)
Report the NDC number for drugs and the quantity information as indicated below.

Paper Claims — CMS-1500 Claim Form

• Submit the NDC code in Block 19, Additional Claim Information
• Submit the units in Field G Days or Units field

Electronic Claims

• Submit the NDC code in Loop 2410 — The NDC is to be preceded with the qualifier N4 and followed immediately by the 11-digit NDC code
• Submit the units in the Nation Drug Unit Count field

Reporting Two NDCs
When providers need to report two NDC numbers for one drug, the additional NDC should be reported in item 19 of the CMS-1500 claim form or in the item 19 electronic equivalent for electronic claims. Do not report multiple lines of the same drug. Submitting multiple lines for the same drug will result in duplicate denials and subsequent appeals.

Report Multiple NDCs for the same drug as follows.

Paper Claims – CMS-1500 Claim Form

• Submit the NDC codes in Block 19, Additional Claim Information
• Submit the units in Field G Days or Units field

Electronic Claims

• Submit the initial NDC code in Loop 2410
• Submit the units in the Nation Drug Unit Count field
• Submit the additional NDC code in Loop 2400; Segment NTE02
   

Example of Multiple NDC Submissions

Patient received 280 mg of J3262 (Tocilizumab injection 1 mg) report the following:

• J3262 HCPCS description is injection Tocilizumab 1 mg
• One unit represents 1 mg ordered and administered per patient
• Code J3262 is billed based on units, not the total number of milligrams

Calculate:

280 mg administered ÷ 1 mg per description = 280 units.

Use the NDC that closely matches the units administered.

The following NDCs represent J3262:

NDC 50242-0135-01 = 80

NDC 50242-0136-01 = 200 

CMS-1500 Claim Form

Important: Do not report multiple lines of the same drug. Submitting multiple lines for the same drug will result in duplicate denials and subsequent appeals.